Outcomes After Medial Quadriceps Tendon Femoral Ligament Reconstruction in Adolescent Patients

Recurrent lateral patellar instability is common in adolescent patients, often requiring surgical intervention. Medial quadriceps tendon femoral ligament reconstruction (MQTFLR) has emerged as an alternative to medial patellofemoral ligament reconstruction, avoiding patellar fixation and its associated complications. However, data on short-term clinical outcomes and return to activity (RTA) following MQTFLR in adolescent patients remain limited.

To evaluate short-term clinical outcomes and RTA following MQTFLR in adolescent patients with recurrent lateral patellar instability.

Case series; Level of evidence, 4.

Adolescent patients (≤19 years) who underwent primary allograft MQTFLR at a single institution between 2017 and 2023 were retrospectively reviewed. Inclusion criteria required both pre- and postoperative patient-reported outcomes (PROs) with a minimum 1-year follow-up. The primary outcome was the change from baseline in PROs, including scores on the Pediatric International Knee Documentation Committee Subjective Knee Evaluation Form (Pedi-IKDC), the Tegner Activity Scale, and the Lysholm Knee Scoring Scale. RTA rates and complications were also assessed. A Wilcoxon signed-rank test was used to compare pre- and postoperative PROs, with P≤ .05 considered statistically significant.

A total of 43 patients (mean age 15 ± 1.8 years, 58% female) underwent MQTFLR. Multiple preoperative dislocations were reported in 63%, and 23% underwent simultaneous tibial tubercle osteotomy. Median follow-up was 24.0 months (IQR, 12.6-24.3). RTA data were available for 33 patients, with 82% attempting to return to their primary activity and 89% of those returning at the same or higher level. Statistically significant improvements were observed in Pedi-IKDC (58.70 [50.55-67.94] to 95.65 [80.98-98.37]; P < .001), Tegner (3.00 [2.00-4.00] to 8.00 [5.50-9.00]; P < .001), and Lysholm (74.00 [54.50-83.50] to 95.00 [85.00-100.00]; P < .001) scores. Three patients (6.9%) experienced recurrent patellar instability at an average of 33.4 months postsurgery.

MQTFLR is a safe and effective surgical option for adolescent patients with recurrent lateral patellar instability, resulting in significant improvements in PROs and a high rate of RTA at the same or higher level. Further research is needed to assess long-term outcomes and identify factors that may influence postoperative recovery.