Purpose
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-Rs 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° to 9.4 ± 6.5° (P < .001). All patients had statistically significant (P < .001) improvement in mean International Knee Documentation Committee (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). The majority of patients (96.9%)
returned to sports, with 90.3% returning to the same or greater level of activity.
No postoperative dislocations or subluxations were reported.
Conclusions
Arthroscopically assisted double-bundle MPFC-R 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 minimal clinically important difference in 95.2% patients, and 66.7%
surpassed the patient acceptable symptomatic state based on postoperative IKDC score
with no redislocations being reported at latest follow-up.
Level of Evidence
Level IV, case series, retrospective.
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Article info
Publication history
Published online: July 12, 2022
Accepted:
June 26,
2022
Received:
January 11,
2022
Footnotes
See commentary on page 112
The authors report the following potential conflicts of interest or sources of funding: This work was supported by grants from the National Natural Science Foundation of China, China (Grant Nos. 81902208); Beijing Natural Science Foundation (grant No. 7172234); and Beijing Nova Program, China (Grant No. Z201100006820011) from Beijing Municipal Science & Technology Commission. ICMJE author disclosure forms are available for this article online, as supplementary material.Wei-Li Shi and Feng-Yi Hu contributed equally to this work.
Identification
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© 2022 by the Arthroscopy Association of North America
