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Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 11, pp 1563–1573 | Cite as

Does patella alta lead to worse clinical outcome in patients who undergo isolated medial patellofemoral ligament reconstruction? A systematic review

  • Anna Bartsch
  • Bart Lubberts
  • Marcus Mumme
  • Christian Egloff
  • Geert Pagenstert
Arthroscopy and Sports Medicine
  • 90 Downloads

Abstract

Introduction

The aim of this systematic review is to determine the effect of patella height on clinical outcomes after isolated MPFL reconstruction for patella instability. Our primary hypothesis is that patients with patella alta report similar outcomes after isolated MPFL reconstruction compared to patients with normal patella height.

Methods

A review of the literature was performed according to the PRISMA guidelines. PubMed, EMBASE, and the Cochrane Library were searched from inception to January 10th 2018. Studies were identified using synonyms for “medial patellofemoral ligament”, “reconstruction” and “patella alta”.

Results

The search resulted in 467 reports on PubMed, 175 on EMBASE and 3 on the Cochrane Library. We included and analyzed in detail six studies describing outcomes after isolated medial patellofemoral ligament reconstruction with regard to patellar height. We found that both patients with patella alta and normal patella height reported satisfactory outcomes after isolated medial patellofemoral ligament reconstruction. However, because of applied exclusion criteria in the included studies the total number of patients with severe patella alta was small (13/74 patients with patella alta, 18%).

Conclusions

Based on the current literature we suggest that additional tibial tubercle distalisation is not mandatory in patients with mild patella alta (Caton–Deschamps Index 1.2–1.4). To assess the best indications for different surgical procedures for patients with patella instability future research is needed to develop a clear and uniform definition of relevant patella alta.

Level of evidence

III.

Keywords

Patella alta Outcomes Medial patellofemoral ligament Knee Surgery 

Notes

Funding

There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

402_2018_2971_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 KB)

References

  1. 1.
    Simmons E Jr, Cameron JC (1992) Patella alta and recurrent dislocation of the patella. Clin Orthop Relat Res 1992:265–269Google Scholar
  2. 2.
    Runow A (1983) The dislocating patella. Etiology and prognosis in relation to generalized joint laxity and anatomy of the patellar articulation. Acta Orthop Scand Suppl 201:1–53CrossRefGoogle Scholar
  3. 3.
    Leung YF, Wai YL, Leung YC (1996) Patella alta in southern China. A new method of measurement. Int Orthop 20:305–310CrossRefGoogle Scholar
  4. 4.
    Larsen E, Lauridsen F (1982) Conservative treatment of patellar dislocations. Influence of evident factors on the tendency to redislocation and the therapeutic result. Clin Orthop Relat Res 171:131–136Google Scholar
  5. 5.
    Geenen E, Molenaers G, Martens M (1989) Patella alta in patellofemoral instability. Acta Orthop Belg 55:387–393PubMedGoogle Scholar
  6. 6.
    Caton J, Mironneau A, Walch G, Levigne C, Michel CR (1990) [Idiopathic high patella in adolescents. Apropos of 61 surgical cases]. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur 76:253–260PubMedGoogle Scholar
  7. 7.
    Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 28:472–479CrossRefGoogle Scholar
  8. 8.
    Phillips CL, Silver DA, Schranz PJ, Mandalia V (2010) The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg Br 92:1045–1053CrossRefGoogle Scholar
  9. 9.
    Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) [Patella infera. Apropos of 128 cases]. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur 68:317–325PubMedGoogle Scholar
  10. 10.
    Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104CrossRefGoogle Scholar
  11. 11.
    Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59:241–242CrossRefGoogle Scholar
  12. 12.
    Biedert RM, Albrecht S. The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc. 2006;14:707–712CrossRefGoogle Scholar
  13. 13.
    Bernageau J, Goutallier D, Debeyre J, Ferrane J (1975) [New exploration technic of the patellofemoral joint. Relaxed axial quadriceps and contracted quadriceps]. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur 61(Suppl 2):286–290Google Scholar
  14. 14.
    Sanchis-Alfonso V (2014) Guidelines for medial patellofemoral ligament reconstruction in chronic lateral patellar instability. J Am Acad Orthop Surg 22:175–182CrossRefGoogle Scholar
  15. 15.
    Marteau E, Burdin P, Brilhault JM (2011) Gracilis tendon transfer associated with distal alignment for patella alta with recurrent dislocations: an original surgical technique. OTSR 97:S5–S11Google Scholar
  16. 16.
    Schöttle PB, Fucentese SF, Romero J (2005) Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 13:516–521CrossRefGoogle Scholar
  17. 17.
    Howells NR, Barnett AJ, Ahearn N, Ansari A, Eldridge JD (2012) Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Ser B 94(B):1202–1208CrossRefGoogle Scholar
  18. 18.
    Ahmad R, Calciu M, Jayasekera N, Schranz P, Mandalia V (2017) Combined medial patellofemoral ligament reconstruction and tibial tubercle transfer results at a follow-up of 2 years. J Knee Surg 30:42–46Google Scholar
  19. 19.
    Weber AE, Nathani A, Dines JS, Allen AA, Shubin-Stein BE, Arendt EA et al (2016) An algorithmic approach to the management of recurrent lateral patellar dislocation. J Bone Joint Surg Am 98:417–427CrossRefGoogle Scholar
  20. 20.
    Laprade RF, Spiridonov SI, Nystrom LM, Jansson KS (2012) Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthroscopy 28:354–364CrossRefGoogle Scholar
  21. 21.
    Brouwer R, Bierma-Zeinstra S, Koeveringe A, Verhaar J (2005) Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. J Bone Joint Surg Br 2005:1227–1232CrossRefGoogle Scholar
  22. 22.
    Payne J, Rimmke N, Schmitt LC, Flanigan DC, Magnussen RA (2015) The incidence of complications of tibial tubercle osteotomy: a systematic review. Arthroscopy 31:1819–1825CrossRefGoogle Scholar
  23. 23.
    Endres S, Wilke A (2011) A 10 year follow-up study after Roux-Elmslie-Trillat treatment for cases of patellar instability. BMC Musculoskelet Disord 12:48CrossRefGoogle Scholar
  24. 24.
    Luhmann SJ, Fuhrhop S, O’Donnell JC, Gordon JE (2011) Tibial fractures after tibial tubercle osteotomies for patellar instability: a comparison of three osteotomy configurations. J Children’s Orthop 5:19–26CrossRefGoogle Scholar
  25. 25.
    Bonnin M, Amendola NA, Bellemans J, MacDonald SJ, Menetrey J (2013) The knee joint: surgical techniques and strategies. Springer, ParisGoogle Scholar
  26. 26.
    Koeter S, Diks MJ, Anderson PG, Wymenga AB (2007) A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg Br 89:180–185CrossRefGoogle Scholar
  27. 27.
    Sherman SL, Erickson BJ, Cvetanovich GL, Chalmers PN, Farr J 2nd, Bach BR Jr et al (2014) Tibial tuberosity osteotomy: indications, techniques, and outcomes. Am J Sports Med 42:2006–2017CrossRefGoogle Scholar
  28. 28.
    Radin EL. The Maquet procedure–anterior displacement of the tibial tubercle. Indications, contraindications, and precautions. Clin Orthop Relat Res. 1986:241–248Google Scholar
  29. 29.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:e1000100CrossRefGoogle Scholar
  30. 30.
    Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 340:c332CrossRefGoogle Scholar
  31. 31.
    Arendt EA, Moeller A, Agel J (2011) Clinical outcomes of medial patellofemoral ligament repair in recurrent (chronic) lateral patella dislocations. Knee Surg Sports Traumatol Arthrosc 19:1909–1914CrossRefGoogle Scholar
  32. 32.
    Becher C, Kley K, Lobenhoffer P, Ezechieli M, Smith T, Ostermeier S (2014) Dynamic versus static reconstruction of the medial patellofemoral ligament for recurrent lateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc 22:2452–2457CrossRefGoogle Scholar
  33. 33.
    Brief LP (1993) Lateral patellar instability: treatment with a combined open-arthroscopic approach. Arthroscopy 9:617–623CrossRefGoogle Scholar
  34. 34.
    Hiemstra LA, Kerslake S, Lafave M (2017) Medial patellofemoral ligament reconstruction femoral tunnel accuracy: relationship to disease-specific quality of life. Orthop J Sports Med 5:2325967116687749PubMedPubMedCentralGoogle Scholar
  35. 35.
    Hohne S, Gerlach K, Irlenbusch L, Schulz M, Kunze C, Finke R (2017) Patella Dislocation in Children and Adolescents. Zeitschrift fur Orthopadie Unfallchirurgie 155:169–176Google Scholar
  36. 36.
    Kita K, Tanaka Y, Toritsuka Y, Amano H, Uchida R, Takao R et al (2015) Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis. Am J Sports Med 43:2988–2996CrossRefGoogle Scholar
  37. 37.
    Khemka A, Lord SJ, Doyle Z, Bosley B, Al Muderis M (2016) Minimally invasive medial patellofemoral ligament reconstruction for patellar instability using an artificial ligament: a two year follow-up. Knee 23:261–266CrossRefGoogle Scholar
  38. 38.
    Kohn LM, Meidinger G, Beitzel K, Banke IJ, Hensler D, Imhoff AB et al (2013) Isolated and combined medial patellofemoral ligament reconstruction in revision surgery for patellofemoral instability: a prospective study. Am J Sports Med 41:2128–2135CrossRefGoogle Scholar
  39. 39.
    Lykissas MG, Li T, Eismann EA, Parikh SN (2014) Does medial patellofemoral ligament reconstruction decrease patellar height? A preliminary report. Journal of pediatric orthopedics 34:78–85CrossRefGoogle Scholar
  40. 40.
    McCarthy M, Ridley TJ, Bollier M, Wolf B, Albright J, Amendola A (2013) Femoral tunnel placement in medial patellofemoral ligament reconstruction. Iowa Orthop J 33:58–63PubMedPubMedCentralGoogle Scholar
  41. 41.
    Nelitz M, Williams RS, Lippacher S, Reichel H, Dornacher D (2014) Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients. Int Orthop 38:2265–2272CrossRefGoogle Scholar
  42. 42.
    Neri T, Philippot R, Carnesecchi O, Boyer B, Farizon F (2015) Medial patellofemoral ligament reconstruction: clinical and radiographic results in a series of 90 cases. Orthop Traumatol Surg Res 101:65–69CrossRefGoogle Scholar
  43. 43.
    Petersen D (1968) The results of gracilis plasty in habitual dislocation of the patella. Chirurg 39:74–76Google Scholar
  44. 44.
    Raghuveer RK, Mishra CB (2012) Reconstruction of medial patellofemoral ligament for chronic patellar instability. Ind J Orthop 46:447–454Google Scholar
  45. 45.
    Schöttle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76:693–698CrossRefGoogle Scholar
  46. 46.
    Tateishi T, Tsuchiya M, Motosugi N, Asahina S, Ikeda H, Cho S et al (2011) Graft length change and radiographic assessment of femoral drill hole position for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19:400–407CrossRefGoogle Scholar
  47. 47.
    Vitale TE, Mooney B, Vitale A, Apergis D, Wirth S, Grossman MG (2016) Physical therapy intervention for medial patellofemoral ligament reconstruction after repeated lateral patellar subluxation/dislocation. Int J Sports Phys Ther 11:423–435Google Scholar
  48. 48.
    Vivod G, Verdonk P, Drobnič M (2014) Long-term clinical and radiographic outcome of patello-femoral realignment procedures: a minimum of 15-year follow-up. Knee Surg Sports Traumatol Arthrosc. ;22:2747–2755CrossRefGoogle Scholar
  49. 49.
    Arendt EA (2015) Trochleoplasty for treatment of patella instability: a prospective study. Orthop J Sports Med 3:2325967115S00037PubMedCentralGoogle Scholar
  50. 50.
    Berard JB, Magnussen RA, Bonjean G, Ozcan S, Lustig S, Neyret P et al (2014) Femoral tunnel enlargement after medial patellofemoral ligament reconstruction: prevalence, risk factors, and clinical effect. Am J Sports Med 42:297–301CrossRefGoogle Scholar
  51. 51.
    Hopper GP, Leach WJ, Rooney BP, Walker CR, Blyth MJ (2014) Does degree of trochlear dysplasia and position of femoral tunnel influence outcome after medial patellofemoral ligament reconstruction? Am J Sports Med 42:716–722CrossRefGoogle Scholar
  52. 52.
    Mulliez A, Lambrecht D, Verbruggen D, Van Der Straeten C, Verdonk P, Victor J (2015) Clinical outcome in MPFL reconstruction with and without tuberositas transposition. Knee Surg Sports Traumatol Arthrosc 25:2708–2714CrossRefGoogle Scholar
  53. 53.
    Krych AJ, O’Malley MP, Johnson NR, Mohan R, Hewett TE, Stuart MJ et al (2016) Functional testing and return to sport following stabilization surgery for recurrent lateral patellar instability in competitive athletes. Knee Surg Sports Traumatol Arthrosc 26(3):711–718Google Scholar
  54. 54.
    Steiner TM, Torga-Spak R, Teitge RA (2006) Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 34:1254–1261CrossRefGoogle Scholar
  55. 55.
    Tischer T, Geier A, Lenz R, Woernle C, Bader R (2016) Impact of the patella height on the strain pattern of the medial patellofemoral ligament after reconstruction: a computer model-based study. Knee Surg Sports Traumatol Arthrosc 25(10):3123–3133Google Scholar
  56. 56.
    Thaunat M, Erasmus PJ (2008) Recurrent patellar dislocation after medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16:40–43CrossRefGoogle Scholar
  57. 57.
    Shelbourne KD, Urch SE, Gray T (2012) Results of medial retinacular imbrication in patients with unilateral patellar dislocation. J Knee Surg 25:391–396CrossRefGoogle Scholar
  58. 58.
    Kim TS, Kim HJ, Ra IH, Kyung HS (2015) Medial patellofemoral ligament reconstruction for recurrent patellar instability using a gracilis autograft without bone tunnel. CiOS Clin Orthop Surg 7:457–464Google Scholar
  59. 59.
    Kita K, Tanaka Y, Toritsuka Y, Amano H, Uchida R, Shiozaki Y et al (2017) 3D computed tomography evaluation of morphological changes in the femoral tunnel after medial patellofemoral ligament reconstruction with hamstring tendon graft for recurrent patellar dislocation. Am J Sports Med 45:1599–1607CrossRefGoogle Scholar
  60. 60.
    Thaunat M, Erasmus PJ (2007) The favourable anisometry: an original concept for medial patellofemoral ligament reconstruction. Knee 14:424–428CrossRefGoogle Scholar
  61. 61.
    Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G (2013) The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 21:318–324CrossRefGoogle Scholar
  62. 62.
    Liu JN, Brady JM, Kalbian IL, Strickland SM, Ryan CB, Nguyen JT et al (2018) Clinical outcomes after isolated medial patellofemoral ligament reconstruction for patellar instability among patients with trochlear dysplasia. Am J Sports Med 2018:363546517745625Google Scholar
  63. 63.
    Clark D, Walmsley K, Schranz P, Mandalia V (2017) Tibial tuberosity transfer in combination with medial patellofemoral ligament reconstruction: surgical technique. Arthrosc Tech 6:e591–e7CrossRefGoogle Scholar
  64. 64.
    Watson NA, Duchman KR, Grosland NM, Bollier MJ (2017) Finite element analysis of patella alta: a patellofemoral instability model. Iowa Orthop J 37:101–108PubMedPubMedCentralGoogle Scholar
  65. 65.
    Redler LH, Meyers KN, Brady JM, Dennis ER, Nguyen JT, Shubin Stein BE (2017) Anisometry of medial patellofemoral ligament reconstruction in the setting of increased tibial tubercle-trochlear groove distance and patella alta. Arthroscopy.  https://doi.org/10.1016/j.arthro.2017.08.256 CrossRefPubMedGoogle Scholar
  66. 66.
    Schuttler KF, Hoeger A, Heyse TJ, Figiel J, Timmesfeld N, Stein T et al (2018) Femoral tunnel widening is associated with tunnel malposition but not with clinical failure after medial patellofemoral ligament reconstruction with a free gracilis tendon graft. Arch Orthop Trauma Surg.  https://doi.org/10.1007/s00402-018-2923-z CrossRefPubMedGoogle Scholar
  67. 67.
    Best R, Hingelbaum S, Huth J, Mauch F (2016) MRI-associated classification to evaluate the outcome after autologous reconstruction of the medial patellofemoral ligament: a preliminary study. Arch Orthop Trauma Surg 136:249–255CrossRefGoogle Scholar
  68. 68.
    Servien E, Verdonk PC, Neyret P (2007) Tibial tuberosity transfer for episodic patellar dislocation. Sports Med Arthrosc Rev 15:61–67CrossRefGoogle Scholar
  69. 69.
    Tjoumakaris FP, Forsythe B, Bradley JP (2010) Patellofemoral instability in athletes: treatment via modified Fulkerson osteotomy and lateral release. Am J Sports Med 38:992–999CrossRefGoogle Scholar
  70. 70.
    Cosgarea AJ, Freedman JA, McFarland EG (2001) Nonunion of the tibial tubercle shingle following Fulkerson osteotomy. Am J Knee Surg 14:51–54Google Scholar
  71. 71.
    Frosch KH, Schmeling A (2016) A new classification system of patellar instability and patellar maltracking. Archives of orthopaedic trauma surgery 136:485–497CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Anna Bartsch
    • 4
    • 5
  • Bart Lubberts
    • 4
  • Marcus Mumme
    • 4
  • Christian Egloff
    • 4
  • Geert Pagenstert
    • 1
    • 2
    • 3
  1. 1.Department of Clinical ResearchUniversity of BaselBaselSwitzerland
  2. 2.Knee Institute BaselBaselSwitzerland
  3. 3.CLARAHOF Clinic of Orthopaedic SurgeryMerian-Iselin-Hospital BaselBaselSwitzerland
  4. 4.Department of Orthopedics and TraumatologyUniversity Hospital BaselBaselSwitzerland
  5. 5.Heidelberg UniversityHeidelbergGermany

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