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. 2022 Feb 25;10(2):23259671211068404.
doi: 10.1177/23259671211068404. eCollection 2022 Feb.

Outcomes of Patellar Stabilization Utilizing a Combined Arthroscopic and Open Technique: A Retrospective Review With 5-Year Follow-up

Maj Liang Zhou  1   2 , Cpt Christian A Cruz  1 , Maj Zackary A Johnson  1 , Craig R Bottoni  1   2
Affiliations

Outcomes of Patellar Stabilization Utilizing a Combined Arthroscopic and Open Technique: A Retrospective Review With 5-Year Follow-up

Maj Liang Zhou et al. Orthop J Sports Med. .

Abstract

Background: Few studies have reported the long-term outcomes of patellar stabilization surgery in an active duty military cohort.

Purpose: To evaluate the long-term results of a combined open and arthroscopic patellar stabilization technique for the treatment of recurrent lateral patellar instability in members of a military population.

Study design: Case series; Level of evidence, 4.

Methods: We performed a retrospective review of a consecutive series of 63 patients who underwent operative management for patellar instability at a tertiary military medical center between 2003 and 2017. All cases were performed by a single sports medicine fellowship-trained orthopaedic surgeon. Patients with recurrent lateral patellar instability whose nonoperative management failed were included. All patients underwent arthroscopic imbrication of the medial patellar retinaculum, an open lateral retinacular release, and an Elmslie-Trillat tibial tubercle osteotomy. Outcome measures at final follow-up included recurrent instability, need for surgical revision, subjective assessments, and military-specific metrics. We also analyzed anatomic risk factors for failure: patella alta, coronal plane alignment, trochlear dysplasia, and tibial tubercle-trochlear groove distance.

Results: A total of 51 patients were included (34 men, 17 women; mean ± SD age at surgery, 27.2 ± 5.8 years; mean follow-up, 5.3 years). The mean postoperative SANE score (Single Assessment Numeric Evaluation) was 75.0 ± 17.7, and the mean visual analog scale pain score was 2.5 ± 2.1. Four patients (7.8%) reported redislocation events, and 4 underwent revision surgery. Twenty-five patients (49.0%) reported a decrease in activity level as compared with preinjury, while 10 (19.6%) cited restrictions in activities of daily living. Of the 21 patients remaining on active duty, 6 (28.6%) required an activity-limiting medical profile. Of the 48 active duty patients, 12 (25.0%) underwent evaluation by a medical board for separation from the military. Differences in the Caton-Deschamps Index and tibial tubercle-trochlear groove distance between surgical success and failure were not statistically significant.

Conclusion: Surgical management of patellar instability utilizing a multifaceted technique resulted in low recurrence rates and may be independent of predisposing anatomic risk factors for instability. At 5-year follow-up, most patients retained their active duty status, although nearly half experienced a decrease in activity level.

Keywords: knee; ligaments; military training; osteotomy; patella; sports trauma.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: L.Z. has received grant support from Arthrex and hospitality payments from Stryker. Z.A.J. has received education payments from ImpactOrtho. C.R.B. has received education payments and nonconsulting fees from Arthrex and honoraria from Musculoskeletal Transplant Foundation. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flowchart. CT, computed tomography; MRI, magnetic resonance imaging; TT-TG, tibial tubercle–trochlear groove.
Figure 2.
Figure 2.
(A) Arthroscopic medial patellofemoral ligament imbrication. The No. 2 nonabsorbable sutures were tied using arthroscopic knots. (B) Postoperative lateral radiograph demonstrating tibial tubercle osteotomy with cortical screws (2 × 4.5 mm).
Figure 3.
Figure 3.
Pre- and postoperative visual analog scale pain scores. Error bars indicate standard deviations.
See this image and copyright information in PMC

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