Tibial Tubercle Osteotomy With Concomitant Medial Patellofemoral Ligament Reconstruction

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanics

Background:

• Patellofemoral instability is often linked to medial patellofemoral ligament (MPFL) tears, occurring in up to 96% of lateral patellar dislocations.
• Maltracking and increased tibial tubercle to trochlear groove (TT-TG) distance are significant risk factors for recurrent patellar instability.

Purpose of the Study:

• To evaluate the efficacy of medial patellofemoral ligament reconstruction (MPFLR) combined with tibial tubercle osteotomy (TTO) for treating patellar instability.
• To assess the impact of concurrent TTO on outcomes in patients with maltracking and elevated TT-TG distance.

Main Methods:

• The study describes a surgical technique involving MPFLR using a semitendinosus allograft and concurrent TTO.
• The TTO procedure involves osteotomy, medialization of the tibial tubercle, and fixation with screws.
• MPFLR graft fixation is achieved using anchors at the patella and an interference screw at the femur's Schöttle point.

Main Results:

• Studies indicate improved outcomes for MPFLR + TTO compared to isolated MPFL reconstruction in patients with maltracking and increased TT-TG distance.
• A meta-analysis confirmed that concurrent TTO does not negatively affect the timeline for returning to sports.

Conclusions:

• MPFLR with concurrent TTO is an effective treatment for patellar instability, addressing underlying maltracking.
• This combined surgical approach facilitates a satisfactory return to sport for patients with recurrent instability and increased TT-TG distance.