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Clinical and radiological results after one hundred fifteen MPFL reconstructions with or without tibial tubercle transfer in patients with recurrent patellar dislocation—a mean follow-up of 5.4 years

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Abstract

Purpose

Medial patellofemoral ligament reconstruction (MPFLR) shows low recurrent rates and high satisfaction. Reports on outcome at mid-term follow-up in a large cohort with or without tibial tubercle transfer (TTT) are scarce.

Methods

One hundred six patients (115 knees; 24.3 ± 8.7 years) with recurrent patellar dislocation underwent MPFLR with ipsilateral gracilis autograft and were included in this retrospective follow-up study. In 43 knees, simultaneous TTT was performed for patellar maltracking due to patella alta or increased tibial tubercle trochlear groove distance (TT-TG). Kujala and subjective knee scores were recorded pre- and post-operatively.

Results

Eighty-seven percent of the patients were satisfied at a mean follow-up of 5.4 ± 3.1 years. The Kujala score increased in 81.7% of all knees from 50.9 to 76.2 points (p < 0.01). Patients with a decreased Kujala score were not different in terms of follow-up time, age, trochlear dysplasia, or post-operative patellar height. The decline was related to an increase in pain, whereas functional scores remained identical. There were six patients with persisting instability, three with patellar re-dislocation. Re-operation was necessary in 24 patients (21.2%), mainly for implant removal after TTT and loss of flexion. Performing TTT had no significant influence on the subjective outcome. Patients with more than eight years of follow-up (n = 27) did not show any difference in the subjective outcome parameters, or in osteoarthritis progression.

Conclusion

MPFLR with and without TTT is a reliable treatment option for recurrent patellar dislocation without deterioration at mid-term follow-up. Persisting pain is a major post-operative issue that seems to be unrelated to patellofemoral anatomy.

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Acknowledgments

We thank Rebecca Tollefson, DVM, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Balgrist University Hospital, Orthopaedic Department, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland

    P. M. Tscholl, F. Wanivenhaus, V. Centmaier-Molnar, R. S. Camenzind & S. F. Fucentese

  2. Department of Orthopaedics and Traumatology, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland

    P. M. Tscholl

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  1. P. M. Tscholl
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Tscholl, P.M., Wanivenhaus, F., Centmaier-Molnar, V. et al. Clinical and radiological results after one hundred fifteen MPFL reconstructions with or without tibial tubercle transfer in patients with recurrent patellar dislocation—a mean follow-up of 5.4 years. International Orthopaedics (SICOT) 44, 301–308 (2020). https://doi.org/10.1007/s00264-019-04441-8

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