ATT Osteotomy Combined with Reconstruction of the Medial Patellofemoral Ligament in Patients with the Recurrent Patellar Dislocation
DOI:
https://doi.org/10.63403/re.v32i1.380Keywords:
ATT Osteotomy, MPFL, Patelar Luxation, Trochlear DysplasiaAbstract
Introduction: the aim of the following study was to describe the results of a consecutive series of patients with recurrent patella instability treated by reconstruction of the Medial Patellofemoral Ligament (MPFL) combined with osteotomy of the anterior tibial tubercle (ATT).
Materials and methods: we retrospectively studied twelve knees in eleven patients from January 2017 to January 2024, with recurrent patellar dislocation, TT-TG of 20 mm or greater measured with CT, without alterations in tibial and/or femoral rotation, and minimal follow-up of two years. We evaluate trochlear dysplasia, patellar height, chondral lesion, and anatomical rotations.
Results: average age twenty-one years (16-27). Average follow-up time is three and a half years (2-6). Consolidation time of osteotomy average twelve weeks (8-18). Average Caton-Deschamps index preoperatively 1.25 and postoperatively 0.97. Average preoperative TT-TG 22.9 and postoperatively 7.9. Evaluation at six months with Kujala scores: 93 (75-100), Lysholm score: 92.5 (78-100).
Conclusion: in patients with recurrent patellar instability and trochlear dysplasia, ATT osteotomy combined with reconstruction of the medial patellofemoral ligament (MPFL), it results in a low incidence of instability and is associated in the medium term with very good functional results, a high percentage of return to sport, and a low rate of complications.
Level of evidence: IV
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Allen MM, Krych AJ, Johnson NR, Mohan R, Stuart MJ, Dahm DL. Combined tibial tubercle osteotomy and medial patellofemoral ligament reconstruction for recurrent lateral patellar instability in patients with multiple anatomic risk factors. Arthroscopy. 2018 Aug;34(8):2420-2426.e3. doi: https://doi.org/10.1016/j.arthro.2018.02.049.
Redziniak DE, Diduch DR, Mihalko WM, Fulkerson JP, Novicoff WM, Sheibani-Rad S, et al. Patellar instability. J Bone Joint Surg Am. 2009 Sep;91(9):2264-75.
Drapeau-Zgoralski V, Swift B, Caines A, Kerrigan A, Carsen S, Pickell M. Lateral patellar instability. J Bone Joint Surg Am. 2023 Mar 1;105(5):397-409. doi: https://doi.org/10.2106/JBJS.22.00756.
Howells NR, Barnett AJ, Ahearn N, Ansari A, Eldridge JD. Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br. 2012 Sep;94(9):1202-1208. doi: https://doi.org/10.1302/0301-620X.94B9.28738.
Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001 Sep-Oct;29(5):600-613. doi: https://doi.org/10.1177/03635465010290051301.
Salonen EE, Magga T, Sillanpää PJ, Kiekara T, Mäenpää H, Mattila VM. Traumatic patellar dislocation and cartilage injury: a follow-up study of long-term cartilage deterioration. Am J Sports Med. 2017 May;45(6):1376-1382. doi: https://doi.org/10.1177/0363546516687549.
Franciozi CE, Ambra LF, Albertoni LJB, Debieux P, Granata GSM Jr, Kubota MS, et al. Anteromedial tibial tubercle osteotomy improves results of medial patellofemoral ligament reconstruction for recurrent patellar instability in patients with tibial tuberosity-trochlear groove distance of 17 to 20 mm. Arthroscopy. 2019 Feb;35(2):566-574. doi: https://doi.org/10.1016/j.arthro.2018.10.109.
Caton J. Méthode de mesure de la hauteur de la rotule [Method of measuring the height of the patella]. Acta Orthop Belg. 1989;55(3):385-386.
Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev. 2007 Mar;15(1):39-46. doi: https://doi.org/10.1097/JSA.0b013e31803035ae.
Dejour H, Walch G, Neyret P, Adeleine P. La dysplasie de la trochlée fémorale [Dysplasia of the femoral trochlea]. Rev Chir Orthop Reparatrice Appar Mot. 1990;76(1):45-54.
Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961 Nov;43-B:752-757. doi: https://doi.org/10.1302/0301-620X.43B4.752.
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy. 1993;9(2):159-163. doi: https://doi.org/10.1016/s0749-8063(05)80366-4.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982 May-Jun;10(3):150-154. doi: https://doi.org/10.1177/036354658201000306
Neri T, Philippot R, Carnesecchi O, Boyer B, Farizon F. Medial patellofemoral ligament reconstruction: clinical and radiographic results in a series of 90 cases. Orthop Traumatol Surg Res. 2015 Feb;101(1):65-69. doi: https://doi.org/10.1016/j.otsr.2014.09.023.
Song YF, Wang HJ, Yan X, Yuan FZ, Xu BB, Chen YR. Tibial tubercle osteotomy may not provide additional benefit in treating patellar dislocation with increased tibial tuberosity-trochlear groove distance: a systematic review. Arthroscopy. 2021 May;37(5):1670-1679.e1. doi: https://doi.org/10.1016/j.arthro.2020.12.210.
Sappey-Marinier E, Sonnery-Cottet B, O'Loughlin P, Ouanezar H, Reina Fernandes L, Kouevidjin B, et al. Clinical outcomes and predictive factors for failure with isolated MPFL reconstruction for recurrent patellar instability: a series of 211 reconstructions with a minimum follow-up of 3 years. Am J Sports Med. 2019 May;47(6):1323-1330. doi: https://doi.org/10.1177/0363546519838405.
Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med. 2007 May;35(5):801-804. doi: https://doi.org/10.1177/0363546506296415.
Servien E, Verdonk PC, Neyret P. Tibial tuberosity transfer for episodic patellar dislocation. Sports Med Arthrosc Rev. 2007 Jun;15(2):61-67. doi: https://doi.org/10.1097/JSA.0b013e3180479464.
Kim JM, Sim JA, Yang H, Kim YM, Wang JH, Seon JK. Clinical comparison of medial patellofemoral ligament reconstruction with or without tibial tuberosity transfer for recurrent patellar instability. Am J Sports Med. 2021 Oct;49(12):3335-3343. doi: https://doi.org/10.1177/03635465211037716.
Magnussen RA. Patella alta sees you, do you see it? Am J Orthop (Belle Mead NJ). 2017 Sep/Oct;46(5):229-231.
Smith TO, Walker J, Russell N. Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2007 Nov;15(11):1301-1314. doi: https://doi.org/10.1007/s00167-007-0390-0.
Fisher B, Nyland J, Brand E, Curtin B. Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy. 2010 Oct;26(10):1384-1394. doi: https://doi.org/10.1016/j.arthro.2010.04.005.
Koshino Y, Taniguchi S, Kobayashi T, Samukawa M, Inoue M. Protocols of rehabilitation and return to sport, and clinical outcomes after medial patellofemoral ligament reconstruction with and without tibial tuberosity osteotomy: a systematic review. Int Orthop. 2022 Nov;46(11):2517-2528. doi: https://doi.org/10.1007/s00264-022-05480-4.
Pautasso A, Sabatini L, Capella M, Saccia F, Rissolio L, Boasso G, et al. Anatomic medial patellofemoral ligament (MPFL) reconstruction with and without tibial tuberosity osteotomy for objective patellar instability. Musculoskelet Surg. 2022 Dec;106(4):441-448. doi: https://doi.org/10.1007/s12306-021-00721-y.
Paakkala A, Sillanpää P, Huhtala H, Paakkala T, Mäenpää H. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months. Skeletal Radiol. 2010 Jul;39(7):675-682. doi: https://doi.org/10.1007/s00256-009-0858-8.
Jos S, Shankar S, Anand R, Thomas Manathara L, Paulose B. Outcomes of MPFL reconstruction with tibial tubercle transfer for recurrent patellar instability with high grade trochlear dysplasia in Indian population. J Clin Orthop Trauma. 2021 Jul 1;20:101490. doi: https://doi.org/10.1016/j.jcot.2021.101490.
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