Summary

The study evaluates the impact of medial or lateral displacement of the tibial tuberosity on clinical outcomes one year after combining the Maquet procedure with Autologous Cartilage Implantation (ACI) for patellofemoral cartilage injuries, revealing that although significant improvement was observed in KOOS Quality of Life scores, patients with increased tibial tuberosity to trochlear groove (TT

Abstract

Background

The Maquet tibial tubercle elevating procedure is a well-established surgical intervention for patellofemoral (PF) cartilage injuries. At our institution, we employ a combined approach of the Maquet procedure with Autologous Cartilage Implantation (ACI) for extensive PF cartilage damage. This study aims to evaluate the impact of medial or lateral displacement of the tibial tuberosity on clinical outcomes one year postoperatively.

Methods

From 2014 to 2022, nine patients (10 knees) with PF cartilage injuries who underwent the combined Maquet procedure and ACI were retrospectively reviewed. The mean cartilage defect size was 536.4 ± 213.4 mm². Clinical outcomes were assessed using the Lysholm score, International Knee Documentation Committee (IKDC) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS) across five subscales both preoperatively and one year postoperatively. Patients were divided into two groups based on postoperative changes in the tibial tuberosity to trochlear groove (TT-TG) distance: Group L (increased TT-TG distance) and Group N (no change or decrease in TT-TG distance). Differences in tibial tuberosity elevation, as well as pre- and postoperative scores, were compared between the groups.

Results

There was a significant improvement in KOOS Quality of Life (QOL) scores (preoperative: 45.6 ± 16.4, postoperative: 56.3 ± 15.6) at one year postoperatively. No significant differences about the other clinical outcome measures between pre- and postoperative were observed. Comparing the two groups, there were no significant differences in tibial tuberosity elevation, preoperative Lysholm score, IKDC score, or KOOS subscales. However, postoperative IKDC scores were significantly lower in Group L (51.1 ± 6.4) compared to Group N (68.7 ± 3.3) (p < 0.05). Although there were no significant differences in postoperative Lysholm scores (L: 74.2 ± 16.9, N: 88.3 ± 8.3), KOOS Symptoms (L: 82.1 ± 8.1, N: 92.0 ± 9.4), KOOS Pain (L: 77.8 ± 11.5, N: 86.1 ± 5.6), KOOS Activities of Daily Living (ADL) (L: 87.5 ± 8.5, N: 93.7 ± 3.7), KOOS Sports (L: 53.3 ± 8.2, N: 65.0 ± 14.7), or KOOS QOL (L: 51.0 ± 17.0, N: 64.1 ± 10.7), Group L showed a trend toward lower scores in all measures.

Conclusion

The combined Maquet procedure and ACI resulted in significant improvement in KOOS QOL scores at one year postoperatively. However, Group L was associated with significantly lower IKDC scores and a trend toward poorer outcomes in other measures. These findings suggest that lateral displacement of the tibial tuberosity may be a risk factor for suboptimal clinical outcomes one year after surgery.