Addition of Tibial Tubercle Osteotomy to Combined MPFL Reconstruction and Lateral Retinacular Release not Recommended for Recurrent Patellar Dislocation in Patients with 15 to 20 mm TT-TG

Yuankai Zhang; Kai Nan; Yan Zhao; Xin Zhang; Qichun Song; Lihong Fan; Zhibin Shi; Xiaoqian Dang

doi:10.1055/s-0042-1757593

The Journal of Knee Surgery, Inhaltsverzeichnis

J Knee Surg 2023; 36(13): 1349-1356
DOI: 10.1055/s-0042-1757593

Original Article

Addition of Tibial Tubercle Osteotomy to Combined MPFL Reconstruction and Lateral Retinacular Release not Recommended for Recurrent Patellar Dislocation in Patients with 15 to 20 mm TT-TG

Yuankai Zhang^*

¹The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China

,

Kai Nan^*

¹The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China

²Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China

,

Yan Zhao

¹The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China

,

Xin Zhang

¹The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China

,

Qichun Song

¹The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China

,

Lihong Fan

¹The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China

,

Zhibin Shi

¹The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China

,

Xiaoqian Dang

¹The First Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, People's Republic of China

› Institutsangaben

Abstract

Surgery is the primary treatment for recurrent patellar dislocation. However, there is still a lack of consensus regarding the choice of combined surgical methods due to the complexity of the anatomical factors. This study aimed to investigate the efficacy and radiological changes in medial patellofemoral ligament reconstruction (MPFLR) and lateral retinacular release (LRR) with and without tibial tubercle osteotomy (TTO) for recurrent patellar dislocation in patients with a tibial tubercle-trochlear groove (TT-TG) distance of 15 to 20 mm. Fifty-four patients were enrolled in this retrospective study between 2010 and 2014. The average patient age was 21.6 ± 5.0 years. All patients underwent MPFLR and LRR, and in 18 patients, these procedures were combined with TTO. Patients were evaluated preoperatively and postoperatively for patellar lateral shift, patellar tilt angle, TT-TG distance, Q-angle, Caton–Deschamps index (CDI), Kujala, and Lysholm scores. The minimally clinical important difference was used to compare clinical outcomes between two groups. In the mean follow-up of 82.6 ± 15.9 months, functional scores improved significantly in both groups (p < 0.01). There were no significant differences in postoperative function scores between the two groups (Kujala, p = 0.25, mean difference = 1.5, 95% confidence interval [CI]: –1.4–4.4; Lysholm, p = 0.76, mean difference = –0.6, 95% CI: –5.9–4.7). Additionally, TTO significantly decreased Q-angle (23.6 ± 2.4 vs. 17.4 ± 2.9, p < 0.01), TT-TG (17.1 ± 1.5 vs. 10.4 ± 1.8, p < 0.01), and CDI (1.18 ± 0.12 vs. 1.08 ± 0.07, p < 0.01). Combined MPFLR and LRR with and without TTO are both effective techniques for recurrent patellar dislocation. Additional osteotomy can correct patellar alta and tibial tubercle lateralization. However, given that there were no significant differences in postoperative functional scores or recurrence rate between groups, we may not recommend TTO in addition to MPFLR and LRR in patients with TT-TG of 15 to 20 mm. Long-term and prospective cohort studies are required to assess further outcomes.

Keywords

patellar dislocation - tibial tubercle osteotomy - TT-TG - medial patellofemoral ligament reconstruction - lateral retinacular release

Volltext

Referenzen

References
1 Hiemstra LA, Kerslake S, Lafave M. Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3849-3855
2 Dietrich TJ, Fucentese SF, Pfirrmann CW. Imaging of individual anatomical risk factors for patellar instability. Semin Musculoskelet Radiol 2016; 20 (01) 65-73
3 Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE. The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med 2015; 43 (04) 921-927
4 Diederichs G, Köhlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S. Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 2013; 41 (01) 51-57
5 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
6 Huber C, Zhang Q, Taylor WR, Amis AA, Smith C, Hosseini Nasab SH. Properties and function of the medial patellofemoral ligament: a systematic review. Am J Sports Med 2020; 48 (03) 754-766
7 Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998; 26 (01) 59-65
8 Longo UG, Berton A, Salvatore G. et al. Medial patellofemoral ligament reconstruction combined with bony procedures for patellar instability: current indications, outcomes, and complications. Arthroscopy 2016; 32 (07) 1421-1427
9 Duerr RA, Chauhan A, Frank DA, DeMeo PJ, Akhavan S. An algorithm for diagnosing and treating primary and recurrent patellar instability. JBJS Rev 2016; 4 (09) e2
10 Christoforakis J, Bull AM, Strachan RK, Shymkiw R, Senavongse W, Amis AA. Effects of lateral retinacular release on the lateral stability of the patella. Knee Surg Sports Traumatol Arthrosc 2006; 14 (03) 273-277
11 Panni AS, Tartarone M, Patricola A, Paxton EW, Fithian DC. Long-term results of lateral retinacular release. Arthroscopy 2005; 21 (05) 526-531
12 Caton JH, Dejour D. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 2010; 34 (02) 305-309
13 Tscholl PM, Wanivenhaus F, Centmaier-Molnar V, Camenzind RS, Fucentese SF. 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. Int Orthop 2020; 44 (02) 301-308
14 Tsuda E, Ishibashi Y, Yamamoto Y, Maeda S. Incidence and radiologic predictor of postoperative patellar instability after Fulkerson procedure of the tibial tuberosity for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2012; 20 (10) 2062-2070
15 Koëter S, Diks MJ, Anderson PG, Wymenga AB. A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg Br 2007; 89 (02) 180-185
16 Stephen JM, Dodds AL, Lumpaopong P, Kader D, Williams A, Amis AA. The ability of medial patellofemoral ligament reconstruction to correct patellar kinematics and contact mechanics in the presence of a lateralized tibial tubercle. Am J Sports Med 2015; 43 (09) 2198-2207
17 Zhang Z, Zhang H, Song G, Zheng T, Ni Q, Feng H. Increased femoral anteversion is associated with inferior clinical outcomes after MPFL reconstruction and combined tibial tubercle osteotomy for the treatment of recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 2020; 28 (07) 2261-2269
18 Feng X, Wang F. Clinical outcomes of medial retinaculum plasty versus MPFL reconstruction with concomitant tibial tubercle transfer: a retrospective study. Arch Orthop Trauma Surg 2020; 140 (11) 1759-1766
19 Mulliez A, Lambrecht D, Verbruggen D, Van Der Straeten C, Verdonk P, Victor J. Clinical outcome in MPFL reconstruction with and without tuberositas transposition. Knee Surg Sports Traumatol Arthrosc 2017; 25 (09) 2708-2714
20 Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev 2007; 15 (01) 39-46
21 Lippacher S, Dejour D, Elsharkawi M. et al. Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 2012; 40 (04) 837-843
22 Graf KH, Tompkins MA, Agel J, Arendt EA. Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 2018; 26 (03) 697-704
23 Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 2007; 35 (05) 801-804
24 Sherman SL, Erickson BJ, Cvetanovich GL. et al. Tibial tuberosity osteotomy: indications, techniques, and outcomes. Am J Sports Med 2014; 42 (08) 2006-2017
25 Fulkerson JP, Becker GJ, Meaney JA, Miranda M, Folcik MA. Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med 1990; 18 (05) 490-496 , discussion 496–497
26 Franciozi CE, Ambra LF, Albertoni LJB. et al. Anteromedial tibial tubercle osteotomy improves results of medial patellofemoral ligament reconstruction for recurrent patellar instability in patients with tibial tuberosity-trochlear groove distance of 17 to 20 mm. Arthroscopy 2019; 35 (02) 566-574
27 Nwachukwu BU, Chang B, Voleti PB. et al. Preoperative Short Form Health Survey score is predictive of return to play and minimal clinically important difference at a minimum 2-year follow-up after anterior cruciate ligament reconstruction. Am J Sports Med 2017; 45 (12) 2784-2790
28 Zhao J, Huangfu X, He Y. The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med 2012; 40 (06) 1355-1364
29 Cossey AJ, Paterson R. A new technique for reconstructing the medial patellofemoral ligament. Knee 2005; 12 (02) 93-98
30 Damasena I, Blythe M, Wysocki D, Kelly D, Annear P. Medial patellofemoral ligament reconstruction combined with distal realignment for recurrent dislocations of the patella: 5-year results of a randomized controlled trial. Am J Sports Med 2017; 45 (02) 369-376
31 Migliorini F, Maffulli N, Eschweiler J, Quack V, Tingart M, Driessen A. Lateral retinacular release combined with MPFL reconstruction for patellofemoral instability: a systematic review. Arch Orthop Trauma Surg 2021; 141 (02) 283-292
32 Matsushita T, Kuroda R, Oka S, Matsumoto T, Takayama K, Kurosaka M. Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2438-2444
33 Erickson BJ, Nguyen J, Gasik K, Gruber S, Brady J, Shubin Stein BE. Isolated medial patellofemoral ligament reconstruction for patellar instability regardless of tibial tubercle-trochlear groove distance and patellar height: outcomes at 1 and 2 years. Am J Sports Med 2019; 47 (06) 1331-1337
34 Gao G, Liu P, Xu Y. Treatment of patellar dislocation with arthroscopic medial patellofemoral ligament reconstruction using gracilis tendon autograft and modified double-patellar tunnel technique: minimum 5-year patient-reported outcomes. J Orthop Surg Res 2020; 15 (01) 25
35 Song Y-F, Wang H-J, Yan X. et al. Tibial tubercle osteotomy may not provide additional benefit in treating patellar dislocation with increased tibial tuberosity-trochlear groove distance: a systematic review. Arthroscopy 2021; 37 (05) 1670-1679 .e1
36 Lykissas MG, Li T, Eismann EA, Parikh SN. Does medial patellofemoral ligament reconstruction decrease patellar height? A preliminary report. J Pediatr Orthop 2014; 34 (01) 78-85
37 Hiemstra LA, Kerslake S, Lafave MR, Tucker A. Patella alta is reduced following MPFL reconstruction but has no effect on quality-of-life outcomes in patients with patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 2021; 29 (02) 546-552
38 Luceri F, Roger J, Randelli PS, Lustig S, Servien E. How does isolated medial patellofemoral ligament reconstruction influence patellar height?. Am J Sports Med 2020; 48 (04) 895-900
39 Hiemstra LA, Kerslake S, Loewen M, Lafave M. Effect of trochlear dysplasia on outcomes after isolated soft tissue stabilization for patellar instability. Am J Sports Med 2016; 44 (06) 1515-1523
40 Rouanet T, Gougeon F, Fayard JM, Rémy F, Migaud H, Pasquier G. Sulcus deepening trochleoplasty for patellofemoral instability: a series of 34 cases after 15 years postoperative follow-up. Orthop Traumatol Surg Res 2015; 101 (04) 443-447
41 von Knoch F, Böhm T, Bürgi ML, von Knoch M, Bereiter H. Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Joint Surg Br 2006; 88 (10) 1331-1335
42 Allen MM, Krych AJ, Johnson NR, Mohan R, Stuart MJ, Dahm DL. Combined tibial tubercle osteotomy and medial patellofemoral ligament reconstruction for recurrent lateral patellar instability in patients with multiple anatomic risk factors. Arthroscopy 2018; 34 (08) 2420-2426 .e3
43 Johnson AA, Wolfe EL, Mintz DN, Demehri S, Shubin Stein BE, Cosgarea AJ. Complications after tibial tuberosity osteotomy: association with screw size and concomitant distalization. Orthop J Sports Med 2018; 6 (10) 2325967118803614
44 Camp CL, Heidenreich MJ, Dahm DL, Stuart MJ, Levy BA, Krych AJ. Individualizing the tibial tubercle-trochlear groove distance: patellar instability ratios that predict recurrent instability. Am J Sports Med 2016; 44 (02) 393-399
45 Marquez-Lara A, Andersen J, Lenchik L, Ferguson CM, Gupta P. Variability in patellofemoral alignment measurements on MRI: influence of knee position. AJR Am J Roentgenol 2017; 208 (05) 1097-1102
46 Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S. The position of the tibia tubercle in 0°-90° flexion: comparing patients with patella dislocation to healthy volunteers. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2396-2400
47 Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J. The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 2006; 13 (01) 26-31
48 Anley CM, Morris GV, Saithna A, James SL, Snow M. Defining the role of the tibial tubercle-trochlear groove and tibial tubercle-posterior cruciate ligament distances in the work-up of patients with patellofemoral disorders. Am J Sports Med 2015; 43 (06) 1348-1353
49 Paiva M, Blønd L, Hölmich P, Barfod KW. Effect of medialization of the trochlear groove and lateralization of the tibial tubercle on TT-TG distance: a cross-sectional study of dysplastic and nondysplastic knees. Am J Sports Med 2021; 49 (04) 970-974
50 Hingelbaum S, Best R, Huth J, Wagner D, Bauer G, Mauch F. The TT-TG index: a new knee size adjusted measure method to determine the TT-TG distance. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2388-2395
51 Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S. Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 2012; 40 (05) 1119-1125
52 Mistovich RJ, Urwin JW, Fabricant PD, Lawrence JTR. Patellar tendon-lateral trochlear ridge distance: a novel measurement of patellofemoral instability. Am J Sports Med 2018; 46 (14) 3400-3406