Anteromedial Tibial Tubercle Osteotomy Improves Results of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Patients With Tibial Tuberosity-Trochlear Groove Distance of 17 to 20 mm

PC > Qualis A1

Anteromedial Tibial Tubercle Osteotomy ...

Authors: Franciozi, C.E.; Ambra, L.F.; Albertoni, L.J.B.; Debieux, P.; Granata, G.S.M.; Kubota, M.S.; Carneiro, M.; Abdalla, R.J.; Luzo, M.V.M.; Cohen, M.

FI 4.33

ARTHROSCOPY THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY 180x240

ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, v. 35, p. 566-574, 2019 .

DOI: http://dx.doi.org/10.1016/j.arthro.2018.10.109

aluno Doutorado

Purpose

To compare the midterm clinical outcomes of anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction (TTO+MPFLR) with MPFLR alone (MPFLRa) for the treatment of recurrent patellar instability (RPI) in patients with a tibial tuberosity–trochlear groove (TT-TG) of 17 to 20 mm.

 

Methods

From January 2008 to August 2013, patients with RPI and a TT-TG of 17 to 20 mm were divided into 2 groups: TTO+MPFLR or MPFLRa. Subjects were evaluated for J sign classification (1-4+); patellar glide (1-4+); the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT-TG; and Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores. Kujala improvement was the primary outcome.

 

Results

Forty-two subjects were evaluated, 18 in the TTO+MPFLR group and 24 in the MPFLRa group. Mean follow-up time was 40.86 months (range, 24-60 months). Demographics between the groups were not different. Preoperatively, there was no statistically significant difference between groups regarding J sign classification; patellar glide; the apprehension test; increased femoral anteversion; the Caton index; trochlear dysplasia; TT-TG; and Kujala, Lysholm, IKDC, and Tegner scores. Postoperative J sign classification mean results comparing TTO+MPFLR and MPFLRa, respectively, were 1 and 1.33 (P = .006). Improvement was significantly higher in the TTO+MPFLR group in all scores except for Tegner. Kujala improvement, 30.27 and 23.95, respectively (P = .003), was also clinically significant, favoring TTO+MPFLR. Lysholm improvement was 40.5 and 36.2, respectively (P = .02), and IKDC improvement was 38.59 and 31.6, respectively (P = .002). There were no reported recurrent subluxations or dislocations in either group.

 

Conclusions

TTO+MPFLR resulted in better functional outcome scores and patellar kinematics compared with MPFLRa in the surgical treatment of RPI in patients with a TT-TG distance of 17 to 20 mm.

 

 

© 2013 - 2019 Universidade Federal de São Paulo - Unifesp

Campus São Paulo - Ed. Octávio de Carvalho - Rua Botucatu, 740 - 2º andar - Vila Clementino, São Paulo - SP - ppg.plastica@unifesp.br

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