Medial patellofemoral ligament reconstruction descends the patella: results from an observational retrospective study
José Andreu Castelo1,2, Juan Francisco Londoño3, Jacobo Triviño-Arias3
1Universidad Icesi, Facultad de ciencias de la salud, Calle 18 No. 122-135, Cali, Colombia.
Background:
Patella alta is a known risk factor in recurrent patellofemoral dislocation. It is recommended to add a tibial tubercle distalization osteotomy for managing patella alta. Medial patellofemoral ligament reconstruction (MPFLr) could alter patellar height. The aim of this study is to quantify the possible decreasing effect of the MPFLr on patellar height in patients with patellofemoral instability treated with two different techniques: the anatomical (Schoettle's point) technique and the adductor's tendon sling technique, in three different indexes.
Methods:
Retrospective observational study in patients with recurrent patellofemoral dislocation who underwent medial patellofemoral ligament reconstruction with an anatomical technique and an adductor's tendon sling technique between 2011 and 2020, comparing the preoperative and postoperative patellar height.
Results:
A total of 15 knees and 14 patients were included, with a mean age of 19.2 ± 4.84 years. Eight patients (53.33 %) were treated with the adductor tendon technique and seven (46.67 %) with the anatomic technique. The change between preoperative and postoperative patellar height showed a statistically significant decrease in the three indexes measured, Caton-Deschamps (CD) (p = 0.0017), modified Insall-Salvati (IS) (p = 0.0022), and Blackburne-Peel (BP) (p = 0.0067). No statistically significant difference was found when comparing the delta of patellar descent between anatomic and adductor tendon groups. The mean decrease for the three measurements was 9 %, equivalent to 0.12 for CD, 0.17 for modified IS, and 0.11 for BP.
Conclusion:
MPFL reconstruction contributes to a mild decrease in patellar height. This effect should be considered in surgical planning. Selected cases of patients with subtle patella alta could avoid the need for additional distalization procedures. Both techniques showed to decrease patellar height, and no differences could be demonstrated between them.
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