Abstract
Objectives:
Patellar instability is a functionally limiting condition facing young adults, significantly affecting athletic and daily activities. This study aims to evaluate the effect of trochlear morphology on clinical outcomes following medial patellofemoral ligament reconstruction (MPFLR), with or without tibial tubercle osteotomy (TTO), with a specific focus on return to sport.
Methods:
A retrospective review was conducted on patients who underwent MPFLR, with or without concomitant TTO, at a single urban academic institution between 2014 and 2021. Eligibility criteria included primary unilateral MPFLR, age between 15 and 45 years, and a minimum follow-up duration of 2 years. Patient-reported outcome measures, specifically Kujala, Tegner, visual analog scale (VAS) pain and satisfaction, time to return-to-sport, and recurrent instability were analyzed and compared across different grades of trochlear dysplasia (Dejour A-D).
Results:
Forty-five patients met the inclusion criteria. The mean age of the cohort was 26.0 ± 9.5 years, the mean follow-up was 4.25±1.95 years (range: 2.0-9.7 years). Lastly, 27 subjects (60.0%) underwent concomitant TTO along with their MPFLR procedure. The overall rate of return to sport was 73.3% and the mean time to return to sport for this cohort was 47.0 ± 28.6 weeks . There was no significant difference in VAS pain scores (p=0.364), VAS sports pain scores (p=0.058), VAS satisfaction (p=0.399), Kujala scores (p=0.239), and MPFL-RSI (p=0.677) when comparing A, B, C and D type dysplasia respectively. However, a secondary exploratory analysis which compared the same set of outcomes for Dejour grade C knees to those with non-Dejour C showed that individuals with Dejour C trochlear dysplasia had a significantly lower return to sport rate (50% vs. 85.7%, p=0.027), higher VAS sports pain scores (38.3 ± 35.3 vs. 15.7 ± 18.4, p=0.007), and lower Kujala scores (81.7 ± 18.7 vs. 90.7 ± 1.7, p=0.040) compared to those with any other grade dysplasia. The rate of minor complications following MPFLR was 15.6%, there were no major complications, and there were no significant differences between Dejour grades A, B, C or D and rate of any post-operative complications.
Conclusions:
MPFL reconstruction, with or without TTO, enables a high level of return to sport across patients with mild to moderate trochlear dysplasia. However, for patients with Dejour C dysplasia, careful consideration of additional bony procedures, such as trochleoplasty, may be warranted to improve outcomes and return to sport. This study underlines the importance of individualized treatment strategies based on the severity of trochlear dysplasia to optimize patient recovery and return to athletic activities.
