Medial Patellofemoral Ligament Reconstruction With Concomitant Tibial Tubercle Osteotomy

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• Patellar instability is common in adolescents, often linked to medial patellofemoral ligament rupture.
• Key risk factors include trochlear dysplasia, patella alta, abnormal patellar tilt, and increased tibial tubercle to trochlear groove (TT-TG) distance.

Purpose of the Study:

• To evaluate the efficacy of combined medial patellofemoral ligament reconstruction (MPFLR) and tibial tubercle osteotomy (TTO) for treating patellar instability.
• To compare outcomes of combined MPFLR + TTO versus isolated MPFLR in patients with specific pathoanatomy.

Main Methods:

• A surgical technique involving MPFLR with a semitendinosus allograft and TTO with medialization of the tibial tubercle.
• Diagnostic arthroscopy, osteotomy guided by guidewires, and fixation with K-wires and headless screws.
• Lateral retinacular lengthening and dynamic testing to ensure proper alignment and patellar stability.

Main Results:

• The combined MPFLR + TTO procedure demonstrated improved clinical outcomes and a high return-to-sports rate.
• This combined approach significantly reduced revision rates compared to isolated MPFLR in patients with increased TT-TG distance.
• Enhanced postoperative patellofemoral tracking was observed with the combined procedure.

Conclusions:

• MPFLR + TTO is an effective treatment for patellar instability, particularly in patients with an increased TT-TG distance.
• The combined procedure substantially improves patellofemoral tracking and overall postoperative outcomes compared to MPFLR alone.