Purpose
The purpose of this study was to compare postoperative complication rates between
patients who underwent medial patellofemoral ligament reconstruction (MPFLR) and those
who underwent MPFLR with tibial tubercle osteotomy (TTO) in a large-scale study. A
secondary goal was to investigate demographic associations with outcomes.
Methods
Patients who underwent MPFLR (n = 3,480) or MPFLR-TTO (n = 615) for patellar instability
were identified in the PearlDiver database. Rates of surgery for infection, procedures
for knee stiffness, patellar fracture, and revision MPFLR within 2 years postoperatively
were compared using multivariable logistic regression. Demographic associations with
outcomes were also investigated.
Results
The MPFLR-TTO cohort exhibited a significantly lower rate of revision surgery at 2
years (0.8% vs 1.9%; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.10-0.80;
P = .036) when compared with the MPFLR group. Independent of index procedure, patients
younger than 21 years had significantly lower rates of requiring procedures for knee
stiffness (OR, 0.35; 95% CI, 0.22-0.54; P < .001) and any complication at 2 years (OR, 0.59; 95% CI, 0.45-0.78; P < .001) when compared with older patients. Male patients displayed a significantly
lower rate of requiring procedures for knee stiffness at 2 years than female patients
(OR, 0.46; 95% CI, 0.25-0.78; P = .007). Tobacco use was associated with a significantly higher rate of postoperative
infection at 2 years (OR, 2.35; 95% CI, 1.00-5.38; P = .046).
Conclusions
The MPFLR cohort exhibited higher rates of revision surgery at 2 years compared with
the MPFLR-TTO cohort. Patient age under 21 years was associated with lower rates of
any complication and requiring procedures for knee stiffness, male sex was associated
with a lower rate of requiring procedures for knee stiffness, and tobacco use was
associated with a higher rate of surgery for postoperative infection. This information
can assist surgeons when counseling patients before these procedures are performed.
Level of Evidence
Level III, retrospective, comparative prognostic trial.
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Article info
Publication history
Published online: February 17, 2023
Accepted:
February 2,
2023
Received:
June 24,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: W.M.R.H. is a board or committee member of AANA; is a paid consultant for Arthrex; and is a paid presenter or speaker for Vericel, outside the submitted work. M.K.M. is a board or committee member of and/or is on the editorial or governing board of American Academy of Orthopaedic Surgeons, American Journal of Sports Medicine Electronic Media, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy, Arthroscopy Association of North America, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Ortho Info, Ruth Jackson Orthopaedic Society, and The Forum; is a paid consultant for Arthrex; and is a paid speaker or presenter for Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2023 by the Arthroscopy Association of North America
