AOSSM/AANA Specialty Day 2020-Handout - Outcomes and Reoperation Rates After Tibial Tubercle Transfer and Medial Patellofemoral Ligament Reconstruction

Handout - Outcomes and Reoperation Rates After Tibial Tubercle Transfer and Medial Patellofemoral Ligament Reconstruction

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This study evaluated reoperation rates, risk factors, and patient-reported outcomes following Tibial Tubercle Transfer (TTT), Medial Patellofemoral Ligament Reconstruction (MPFLR), or both, in treating patellofemoral instability (PFI) at a single institution. A retrospective review included 497 patients who underwent these procedures, excluding those with additional ligament reconstructions, non-PFI indications, or incomplete records. Data collected encompassed radiographic measures, demographics, and details of revision surgeries, alongside patient pain assessments.<br /><br />Results showed an overall reoperation rate of 25.6%. The most common reoperations were hardware removal (54 cases) and lysis of adhesions with manipulation under anesthesia (32 cases). Women experienced nearly three times higher reoperation rates than men (p<.0001). Reoperation rates varied by procedure type: MPFLR alone had a 19.9% rate, significantly lower than TTT alone at 34.8%, and combined procedures at 26.4% (p=.007). A higher Caton-Deschamp ratio (≥1.3), indicating patella alta, was associated with more than double the odds of requiring revision stabilization surgery (OR=2.303). Importantly, patients undergoing revision surgeries reported more pain when walking compared to those without reoperation (p<.0001).<br /><br />In conclusion, the study identifies a higher-than-previously-reported reoperation rate after PFI surgery. Female gender and preoperative patella alta are significant risk factors for reoperation. Additionally, those requiring further surgery are more likely to experience persistent knee pain while walking, highlighting the need for careful patient selection and counseling regarding expected outcomes.

Keywords

patellofemoral instability

Tibial Tubercle Transfer

Medial Patellofemoral Ligament Reconstruction

reoperation rate

risk factors

patella alta

Caton-Deschamp ratio

revision surgery

patient-reported outcomes

knee pain