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Arthroscopic Anatomical Double-Bundle Medial Patellofemoral Complex Reconstruction Improves Clinical Outcomes in Treating Recurrent Patellar Instability Despite Trochlear Dysplasia, Elevated TT-TG Distance and Patellar Alta

      Purpose

      The purpose of this study was to evaluate the clinical outcomes of arthroscopically assisted double-bundle medial patellofemoral complex reconstruction (MPFC-R).

      Methods

      A retrospective review was carried out among adult patients who experienced at least 2 patellar dislocations and underwent primary arthroscopically assisted MPFC-R between January 2014 and November 2019. Dejour classification, tibial tubercle–trochlear groove (TT-TG) distance, and patellar height (with Insall-Salvati index) were measured. Pre-and postoperative patellar tilt were compared. Information on outcome scores, ability to return to sports, postoperative recurrent dislocations and complications was recorded.

      Results

      A total of 42 MPFC reconstructions in 39 patients were included. Mean age at surgery was 22.2 ± 7.6 years; 69.2% of patients were female. Mean follow-up was 47.3 ± 20.2 months. Seventy-four percent of cases had Dejour B (19.0%), C (33.3%), and D (21.4%) trochlear dysplasia; mean TT-TG distance was 19.6 ± 3.5 mm, and mean Insall-Salvati index was 1.21 ± 0.17. Mean patellar tilt decreased from 27.6 ± 11.6 degree to 9.4 ± 6.5 degree (P<.001). All patients had statistically significant (P<.001) improvement in mean IKDC (44.9 ± 18.2 to 87.5 ± 6.9), Lysholm (61.4 ± 16.6 to 94.1 ± 6.4), Kujala (56.0 ± 16.8 to 92.9 ± 5.3) and Tegner score (2.7 ± 1.3 to 4.6 ± 1.4). Majority of patients (96.9%) returned to sports, with 90.3% returning to the same or higher level of activity. No postoperative dislocations or subluxations were reported.

      Conclusion

      Arthroscopically assisted double-bundle MPFC reconstruction is a promising procedure to treat recurrent patellar instability at 2-to-7-year mid-term follow-up, despite the presence of trochlear dysplasia, elevated TT-TG distance and patellar alta. The improvement of IKDC score exceeded the MCID in 95.2% patients, and 66.7% surpassed the PASS based on postoperative IKDC score with no redislocations beingreported at latest follow-up.

      Level of Evidence

      Level IV, case series, retrospective.
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