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Clinical outcomes and predictive factors for failure with MPFL reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction combined with tibial tubercle osteotomy (TTO) and lateral retinacular release (LRR) is one of the main treatment methods for patellar instability. So far, few studies have evaluated the clinical effectiveness and assessed potential ris...

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Autores principales: Su, Peng, Liu, Xiumin, Jian, Nengri, Li, Jian, Fu, Weili
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296593/
https://www.ncbi.nlm.nih.gov/pubmed/34289826
http://dx.doi.org/10.1186/s12891-021-04508-x
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author Su, Peng
Liu, Xiumin
Jian, Nengri
Li, Jian
Fu, Weili
author_facet Su, Peng
Liu, Xiumin
Jian, Nengri
Li, Jian
Fu, Weili
author_sort Su, Peng
collection PubMed
description BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction combined with tibial tubercle osteotomy (TTO) and lateral retinacular release (LRR) is one of the main treatment methods for patellar instability. So far, few studies have evaluated the clinical effectiveness and assessed potential risk factors for recurrent patellar instability. PURPOSE: To report the clinical outcomes of MPFL reconstruction combined with TTO and LRR at least three years after operation and to identify potential risk factors for recurrent patellar instability. METHODS: A retrospective analysis of medical records for patients treated with MPFL, TTO and LRR from 2013 to 2017 was performed. Preoperative assessment for imaging examination included trochlear dysplasia according to Dejour classification, patella alta with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance. Postoperative assessment for knee function included Kujala, IKDC and Tegner scores. Failure rate which was defined by a postoperative dislocation was also reported. RESULTS: A total of 108 knees in 98 patients were included in the study. The mean age at operation was 19.2 ± 6.1 years (range, 13–40 years), and the mean follow-up was 61.3 ± 15.4 months (range, 36–92 months). All patients included had trochlear dysplasia (A, 24%; B, 17%; C, 35%; D, 24%), and 67% had patellar alta. The mean postoperative scores of Tegner, Kujala and IKDC were 5.3 ± 1.3 (2–8), 90.5 ± 15.5 (24–100) and 72.7 ± 12.1 (26–86). Postoperative dislocation happened in 6 patients (5.6%). Female gender was a risk factor for lower IKDC (70.7 vs 78.1, P = 0.006), Tegner (5.1 vs 6.0, P = 0.006) and Kujala (88.2 vs 96.6, P = 0.008). Age (p = 0.011) and trochlear dysplasia (p = 0.016) were considered to be two failure factors for MPFL combined with TTO and LRR. CONCLUSION: As a surgical method, MPFL combined with TTO and LRR would be a reliable choice with a low failure rate (5.6%). Female gender was a risk factor for worse postoperative outcomes. Preoperative failure risk factors in this study were age and trochlear dysplasia. LEVEL OF EVIDENCE: Level IV; Case series
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spelling pubmed-82965932021-07-22 Clinical outcomes and predictive factors for failure with MPFL reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability Su, Peng Liu, Xiumin Jian, Nengri Li, Jian Fu, Weili BMC Musculoskelet Disord Research BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction combined with tibial tubercle osteotomy (TTO) and lateral retinacular release (LRR) is one of the main treatment methods for patellar instability. So far, few studies have evaluated the clinical effectiveness and assessed potential risk factors for recurrent patellar instability. PURPOSE: To report the clinical outcomes of MPFL reconstruction combined with TTO and LRR at least three years after operation and to identify potential risk factors for recurrent patellar instability. METHODS: A retrospective analysis of medical records for patients treated with MPFL, TTO and LRR from 2013 to 2017 was performed. Preoperative assessment for imaging examination included trochlear dysplasia according to Dejour classification, patella alta with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance. Postoperative assessment for knee function included Kujala, IKDC and Tegner scores. Failure rate which was defined by a postoperative dislocation was also reported. RESULTS: A total of 108 knees in 98 patients were included in the study. The mean age at operation was 19.2 ± 6.1 years (range, 13–40 years), and the mean follow-up was 61.3 ± 15.4 months (range, 36–92 months). All patients included had trochlear dysplasia (A, 24%; B, 17%; C, 35%; D, 24%), and 67% had patellar alta. The mean postoperative scores of Tegner, Kujala and IKDC were 5.3 ± 1.3 (2–8), 90.5 ± 15.5 (24–100) and 72.7 ± 12.1 (26–86). Postoperative dislocation happened in 6 patients (5.6%). Female gender was a risk factor for lower IKDC (70.7 vs 78.1, P = 0.006), Tegner (5.1 vs 6.0, P = 0.006) and Kujala (88.2 vs 96.6, P = 0.008). Age (p = 0.011) and trochlear dysplasia (p = 0.016) were considered to be two failure factors for MPFL combined with TTO and LRR. CONCLUSION: As a surgical method, MPFL combined with TTO and LRR would be a reliable choice with a low failure rate (5.6%). Female gender was a risk factor for worse postoperative outcomes. Preoperative failure risk factors in this study were age and trochlear dysplasia. LEVEL OF EVIDENCE: Level IV; Case series BioMed Central 2021-07-21 /pmc/articles/PMC8296593/ /pubmed/34289826 http://dx.doi.org/10.1186/s12891-021-04508-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Su, Peng
Liu, Xiumin
Jian, Nengri
Li, Jian
Fu, Weili
Clinical outcomes and predictive factors for failure with MPFL reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability
title Clinical outcomes and predictive factors for failure with MPFL reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability
title_full Clinical outcomes and predictive factors for failure with MPFL reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability
title_fullStr Clinical outcomes and predictive factors for failure with MPFL reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability
title_full_unstemmed Clinical outcomes and predictive factors for failure with MPFL reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability
title_short Clinical outcomes and predictive factors for failure with MPFL reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability
title_sort clinical outcomes and predictive factors for failure with mpfl reconstruction combined with tibial tubercle osteotomy and lateral retinacular release for recurrent patellar instability
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296593/
https://www.ncbi.nlm.nih.gov/pubmed/34289826
http://dx.doi.org/10.1186/s12891-021-04508-x
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