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Combined trochleoplasty and medial patellofemoral ligament reconstruction reduces patellar height
Felix Riechelmann1, Alexa Schaufler1, Nadja Gasser2
1Department of Orthopaedics and Trauma Surgery Medical University of Innsbruck Innsbruck Austria.
Purpose:
This study assessed whether trochleoplasty combined with medial patellofemoral ligament reconstruction (MPFLR) reduces patellar height, potentially obviating the need for distalizing tibial tubercle osteotomy (TTO).
Methods:
Patellar height was evaluated in 73 knees before and at a median of 6 months after patellar stabilisation using the Caton-Deschamps (CDI), Insall-Salvati (ISI) and Blackburne-Peel (BPI) indices.
Results:
MPFL reconstruction with trochleoplasty resulted in a sustained 8.1% postoperative reduction in the CDI (95% confidence interval [CI]: -14.1% to -2.1%; p < 0.001). The reduction was greater with MPFLR plus TTO (16.5%; -23.7% to -9.3%; p < 0.001) and maximal when MPFLR, trochleoplasty and TTO were performed together (22.9%; -33.1% to -12.6%; p < 0.001). ISI and BPI showed comparable reductions. While strong Pearson correlations among the indices (r = 0.6-0.9; all p < 0.001) were observed preoperatively, Bland-Altman analyses revealed a substantial bias of up to 25%. Inter-index agreement for clinical classification (alta, normal, baja) was inconsistent, achieving at best a 'moderate' level (Weighted Cohen's kappa 0.36-0.60).
Conclusion:
Combined MPFL reconstruction and trochleoplasty reduce patellar height by approximately 10%. The interaction effect of various surgical procedures for PFI on patellar height, coupled with methodological inconsistencies in index-based patellar height classification, challenges the validity of rigid cut-off values for distalizing TTO.
Level Of Evidence:
Level III.
