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Combined reconstruction of the medial patellofemoral and medial patellotibial ligaments: outcomes and prognostic factors

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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Abstract

Purpose

To report outcomes after combined medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) reconstruction and test associations between prognostic factors and clinical outcomes. It was hypothesised that combined MPFL and MPTL reconstruction would result in significant improvement in function, and that outcomes would be associated with age, sex, Beighton score, concomitant articular lesions, and preoperative function.

Methods

All combined reconstructions of MPFL and MPTL were reviewed. Inclusion criterion was minimum 2-year follow-up. Exclusion criteria were age at surgery ≥ 35 years and concomitant osteotomies. Kujala, Tegner and Marx scores were completed prospectively. Patients were evaluated at a minimum 2-year follow-up. Associations between potential prognostic factors and Kujala and Tegner scores were tested using bivariate analyses followed by multivariate regression models.

Results

Of 22 patients (26 knees), 19 (23 knees) met inclusion criteria, and 16 (20 knees) were available for follow-up. Mean age at surgery was 18 years (range 14.5–23). Mean follow-up was 43 months (range 24–73). Postoperative Kujala score significantly improved compared to before surgery (86.4 ± 12.5 vs. 54.9 ± 15.2, p < 0.01). Postoperative Tegner score was nonsignificantly higher compared to before surgery (4.8 ± 2.4 vs. 4 ± 3, p = ns) and lower compared to before first patella dislocation (4.8 ± 2.4 vs. 5.9 ± 1.2, p < 0.01). Postoperative Kujala score was associated with male sex (p = 0.02), with medial patellofemoral chondral lesions (p = 0.01) and with preoperative Kujala score (p = 0.05). Postoperative Tegner score was associated with male sex (p < 0.01), with preoperative Tegner level (p < 0.01), and with Beighton score (p < 0.01). Patella apprehension was recorded in two knees (10%) in two patients.

Conclusion

Combined MPFL and MPTL reconstruction in young adults results in significant improvement in subjective knee function with minimal risks, although preinjury activity levels are not consistently restored. Associated factors of improved outcome include higher preoperative knee scores and activity levels, medial patellofemoral chondral lesions, decreased Beighton scores, and male sex. This supports the advisability of the procedure and can also assist in setting realistic goals for specific groups of patients.

Level of evidence

Case series, Level IV.

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Funding

This study did not receive any specific grant or any funding from any funding agency.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel

    Iftach Hetsroni, Gideon Mann, Eran Dolev & Meir Nyska

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Iftach Hetsroni, Gideon Mann & Meir Nyska

Authors
  1. Iftach Hetsroni
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  2. Gideon Mann
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  3. Eran Dolev
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  4. Meir Nyska
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Correspondence to Iftach Hetsroni.

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The authors declare that they have no competing interests.

Ethical approval

The local Institutional Review Board (Meir General Hospital, Kfar Saba, Israel) approved the study protocol (I.D. 0216-13-MMC).

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Hetsroni, I., Mann, G., Dolev, E. et al. Combined reconstruction of the medial patellofemoral and medial patellotibial ligaments: outcomes and prognostic factors. Knee Surg Sports Traumatol Arthrosc 27, 507–515 (2019). https://doi.org/10.1007/s00167-018-5145-6

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  • DOI: https://doi.org/10.1007/s00167-018-5145-6

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