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. 2024 Sep 6;6(6):100994.
doi: 10.1016/j.asmr.2024.100994. eCollection 2024 Dec.

Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone

Alexander R Markes  1 , Ramesh B Ghanta  1 , Alan L Zhang  1 , C Benjamin Ma  1 , Brian T Feeley  1 , Drew A Lansdown  1
Affiliations

Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone

Alexander R Markes et al. Arthrosc Sports Med Rehabil. .

Abstract

Purpose: To use a large nationwide administrative database to directly compare usage, complications, and need for revision stabilization surgery after medial patellofemoral ligament reconstruction (MPLFR), tibial tubercle osteotomy (TTO), and combined MPFLR and TTO (MPFLRTTO).

Methods: The PearlDiver Mariner database was queried for all reported cases of MPLFR, TTO, and combined MPFLRTTO performed between 2010 and 2020 using Current Procedural Terminology codes. Subsets from those cohorts with laterality-specific International Classification of Diseases, Tenth Revision, codes for patellar instability were used to evaluate 2-year incidence of infection, stiffness, fracture, and revision stabilization with MPFLR and/or TTO. Multiple linear regression and χ2 analysis were used to analyze incidence trends and to compare complication rates.

Results: A total of 70,070 patients were identified. MPFLR was found to be the most common procedure (73.1%), followed by TTO (19.2%) and then MPFLRTTO (7.6%). MPLFR was observed to have the lowest overall complication rate (5.4%), whereas both TTO (7.5%) and MPFLRTTO (7.1%) had greater complication rates (P < .001). MPFLR had the greatest rate of revision stabilization surgery at 3.7% compared with TTO at 2.7% and MPFLRTTO, which carried the lowest risk for revision at 2.4% (P < .001).

Conclusions: Isolated MPFLR is the most common modality used for patellar instability, with increasing prevalence and the lowest 2-year complication rate. Isolated TTO was unchanged in its use and had the greatest overall complication rate. Combined MPFLRTTO increased the overall complication rate but had a lower 2-year rate of recurrent instability requiring revision than MPFLR alone.

Level of evidence: Level III, retrospective cohort study.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: D.A.L. reports consulting or advisory with Vericel and AlloSource and educational support from Arthrex. B.T.F. reports Journal Editor, Journal of Shoulder and Elbow Surgery and Current Review in Musculoskeletal Medicine. C.B.M. reports consulting or advisory with Stryker and CONMED and a research grant from Aesculap. A.L.Z. reports consulting or advisory with Stryker, DePuy Synthes Mitek Sports Medicine, and CONMED. All other authors (A.R.M., R.G.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig 1
Annual incidence of patellar stabilization procedures. P < .05 is in reference to P value generated from the multiple linear regression model analyzing change in annual patellar stabilization procedure performed. (MPFL, medial patellofemoral ligament reconstruction; MPFL + TTO, concomitant medial patellofemoral ligament reconstruction and tibial tubercle osteotomy; TTO, tibial tubercle osteotomy.)
See this image and copyright information in PMC

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