Medial Patellofemoral Ligament Reconstruction Combined With Tibial Tuberosity Osteotomy In The Treatment Of Recurrent Patellar Dislocation

Objective To compare the efficacy of tibial tuberosity osteotomy(TTO)combined with medial patellofemoral ligament reconstruction(MPFLR)to TTO in treatment of recurrent patella dislocation associated with patella alta and provide follow-up data for clinical decision making.Methods Part 1.Evaluation of knee function in the treatment of recurrent patellar dislocation by medial patellofemoral ligament reconstruction combined with tibial tuberosity osteotomy From July 2010 to December 2015,50 patients who had recurrent patella dislocation and patella alta were included in this study.There were 15 males and 35 females with an average age of 20.6 years.These patients received surgical treatment and their clinical data were collected and retrospectively analyzed.According to surgical methods,patients were divided into TTO group(32 cases)and MPFLR+TTO group(18 cases),who were followed-up by knee function scores including Tegner,International Knee Documentation Committee(IKDC),Kujala scores,Knee Injury and Osteoarthritis Outcome Score(KOOS).Patellar stability would be checked at the last follow-up.Part 2.Imaging evaluation in the treatment of recurrent patellar dislocation by medial patellofemoral ligament reconstruction combined with tibial tuberosity osteotomy Continuous case collection was used.From March 2011 to January 2015,26 patients(34 knees)who had recurrent patella dislocation and patella alta were included in this study.According to surgical methods,patients were divided into TTO group(12 cases,16 knees)and MPFLR+TTO group(14 cases,18 knees),who were followed-up by CT and lateral X-ray.Changes of patellar tilt Angle(PTA)before and after surgery were compared.Patellar stability would be checked at the last follow-up.Results Part 1.Evaluation of knee function in the treatment of recurrent patellar dislocation by medial patellofemoral ligament reconstruction combined with tibial tuberosity osteotomy 50 cases were followed up for(50.9±17.8)months and(22.3±10.1)months respectively.Two of patients occurred recurrent dislocation in TTO group,who showed positive apprehension test at 0°flexions of knee.While all patients in MPFLR+TTO group did not occur recurrent dislocation,who showed negative apprehension test at 0 °flexions of knee.There were no statistically significant differences between preope rative and postoperative results in TTO group in Tegner cores(P>0.05),KOOS scores in subdomain pain and daily life activities(P>0.05),while differences in the rest of scores were statistically significant(P<0.05).Compared with TTO group,all scores were statistically significant(P<0.05)and KOOS scores in the subdomain pain and of daily life activities were significantly improved postoperatively in MPFLR+TTO group(P<0.05).Part 2.Imaging evaluation in the treatment of recurrent patellar dislocation by medial patellofemoral ligament reconstruction combined with tibial tuberosity osteotomy The preoperative Caton index,TT-TG and PTA were not statistically significant in the two groups(P>0.05).At the last follow-up,there were statistically significant differences in postoperative imaging indexes between the two groups(P<0.05).There was a significant difference in postoperative PTA(P < 0.05)between the two groups,but no statistical difference in Caton index and TT-TG(P>0.05).Conclusion For patients with recurrent patellar dislocation associated with patella alta,both surgical methods were found to be effective.MPFLR+TTO showed more significant postoperative improvement in symptoms of pain,daily life activities and patellofemoral joint alignment,which may lead to more satisfactory efficacy.