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Does Tibial Tuberosity-Trochlear Groove Distance Affect Clinical Outcomes of Medial Patellofemoral Ligament Reconstruction?


Takehiko Matsushita, MD, PhD
JAPAN

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Does Tibial Tuberosity-Trochlear Groove Distance Affect Clinical Outcomes of Medial Patellofemoral Ligament Reconstruction?

Takehiko Matsushita, MD, PhD, JAPAN Ryosuke Kuroda, MD, PhD, JAPAN Shinya Oka, MD, PhD, JAPAN Tomoyuki Matsumoto, MD, PhD, JAPAN Seiji Kubo, MD, PhD, JAPAN Yuichiro Nishizawa, MD, PhD, JAPAN Tokio Matsuzaki, MD, JAPAN Kanto Nagai, MD, PhD, JAPAN Masahiro Kurosaka, MD, JAPAN

Kobe University Graduate School of Medicine, Kobe, JAPAN

2013 Congress   Paper Abstract   2013 Congress   Not yet rated

 

Patient Populations

Pediatric / Adolescent

Anatomic Location

Knee Patellofemoral

Diagnosis / Condition

Dislocation

Diagnosis Method

Physical Examination X-ray CT-Scan

Sports Medicine

Outcome Studies

Treatment / Technique

Autograft Repair / Reconstruction

Patellofemoral

Recurrent Subluxation and Dislocation

Summary: MPFL reconstruction with lateral release can achieve good clinical outcomes in patients with an increased TT-TG distance without performing medialization of tibial tuberosity.

Introduction

Medial patellofemoral ligament (MPFL) reconstruction has been widely performed to treat recurrent patellar dislocation. However the effectiveness of MPFL reconstruction in patients with severely lateralized tibial tuberosity has not been well examined. Some surgeons advocate MPFL reconstruction combined with medialization of tibial tubercle if the patients’ tibial tuberosity-trochlea groove (TT-TG) distance is more than 20 mm. In the present study, we examined clinical outcomes of MFPL reconstruction in patients with a TT-TG distance of more than 20 mm.

Material And Methods

34 patients who received MFPL reconstruction for recurrent patellar dislocation were retrospectively examined for this study. 19 patients with a TT-TG distance of more than 20 mm were examined as an increased TT-TG distance group and compared with 15 patients with a TT-TG distance of less than 20 mm as a control group (Mean follow up; 40 months, 32 months respectively). TT-TG distance was measured using CT images taken at knee extension. MPFL reconstruction was performed using semitendinosus tendon graft. Lateral release was additionally performed for patients with severe tight lateral soft tissue. Clinical outcomes of MPFL reconstruction was evaluated by the presence of redislocation, Crosby and Insall grading system, apprehension sign and congruence angle on axial view of plain radiographs.

Results

The mean TT-TG distance was 22.6±2.5 (20.2-27.2) mm for the increased TT-TG distance group and 15.7±2.6 (11.3-19.0) mm for the control group. There was no significant difference between the two groups in patient age, follow-up duration, the mean sulcus angle and tilting angle. Lateral release was performed in 14 patients (73.7%) in the increased TT-TG distance group and in 8 patients (44.4%) in the control group. None of the patients reported redislocation. With Crosby and Insall grading system, 9 patients were excellent (47%), 10 patients were good (53%) in the increased TT-TG distance group, while 5 were excellent (33.3%), 10 were good (66.6%) in the control group. None was fair to poor and worse in both groups. In the increased TT-TG distance group, apprehension sign was positive in 3 patients and congruence angle was improved from 19.3° to 0.41°.

Conclusions

The overall clinical outcomes after MPFL reconstruction with lateral release were favorable in patients with a TT-TG distance of more than 20 mm although apprehension sign was positive in 3 patients. MPFL reconstruction with lateral release can achieve good clinical outcomes in patients with an increased TT-TG distance and TT-TG distance of more than 20 mm may not be an absolute indication for medialization of tibial tuberosity when performing MFPL reconstruction.