Impact of Lower Extremity Torsion on Clinical Outcomes Following Medial Patellofemoral Ligament Reconstruction

The impact of lower extremity torsion on the clinical outcomes in patients who have undergone isolated medial patellofemoral ligament reconstruction (MPFLR) with artificial tape and suture anchors remains unclear.

To evaluate the association between lower extremity torsion and clinical outcomes following MPFLR using FiberTape and knotless SwiveLock anchors in patients with recurrent patellar instability.

Cohort study; Level of evidence, 3.

This study included 96 knees (65 patients) that underwent MPFLR between 2016 and 2023 with femoral torsion (FT) and tibial torsion (TT) as potential predictors of postoperative outcomes. Preoperative and postoperative assessments included radiographic and computed tomography measurements and clinical evaluations using the Knee injury and Osteoarthritis Outcome Score (KOOS).

Significant improvements were observed in the KOOS subscale scores (pain, symptoms, quality of life, sports, and activities of daily living) 1 year postoperatively. Knees with FT ≤30° showed superior outcomes in symptoms and sports activities compared with those with FT >30°. Multivariate analysis identified increased FT as negatively associated with patients' scores on the sports subscale of the KOOS questionnaire (β = -0.251, P = .009), whereas higher TT was positively associated with sports scores (β = 0.335, P < .001). Receiver operating characteristic analysis identified an FT threshold of 27° as a predictor of postoperative apprehension and symptoms.

These findings underscore the detrimental impact of increased FT on MPFLR outcomes, highlighting the necessity for a comprehensive preoperative assessment of lower extremity torsion. Future research should explore the long-term effects and refine surgical protocols to enhance treatment efficacy.