Meeting NewsPerspective

Addition of tibial tubercle osteotomy to MPFL reconstruction seen as safe, effective

BOSTON — The addition of tibial tubercle osteotomy in patients who underwent medial patellofemoral ligament reconstruction was seen as safe and effective, according to a presenter at the American Orthopaedic Society for Sports Medicine Annual Meeting. Both patients who underwent medial patellofemoral ligament reconstruction with or without tibial tubercle osteotomy saw significant improvements in most subjective outcomes scores.

“Activity scores were higher for the isolated [medial patellofemoral ligament] MPFL cohort at early follow-up” Seth L. Sherman, MD, said during his presentation. “Complication profile was similar between both groups.”

Sherman and colleagues retrospectively reviewed prospectively collected data for 87 patients who underwent soft tissue stabilization with MPFL reconstruction for recurrent patellar instability with or without concomitant tibial tubercle osteotomy. There were 31 patients who underwent MPFL reconstruction with tibial tubercle osteotomy and 55 patients underwent MPFL reconstruction without tibial tubercle osteotomy. Investigators collected preoperative and postoperative patient-reported outcomes, such as the KOOS domains, PROMIS, IKDC, SANE and Marx scores. Complications that needed reoperation were recorded.

Results showed no difference in preoperative outcome scores between the treatment groups. Both groups saw significant improvements in all KOOS domains; however, there were no significant differences between them. Significant improvements were seen in SANE, IKDC and PROMIS scores.

At 6 months, the Marx activity score was significantly different between the two groups. Patients who underwent tibial tubercle osteotomy had a Marx activity score of 0.79 vs. 4.61 in patients who underwent MPFL alone. There were four knees who underwent MPFL- tibial tubercle osteotomy that needed additional surgery and six knees in patients who underwent MPFL alone that needed additional surgery. The overall complication and recurrent instability rates were not significantly different in either group. – by Monica Jaramillo

Reference:

Sherman SL, et al. Abstract 62. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.

Disclosure: Sherman reports he has no relevant financial disclosures.

BOSTON — The addition of tibial tubercle osteotomy in patients who underwent medial patellofemoral ligament reconstruction was seen as safe and effective, according to a presenter at the American Orthopaedic Society for Sports Medicine Annual Meeting. Both patients who underwent medial patellofemoral ligament reconstruction with or without tibial tubercle osteotomy saw significant improvements in most subjective outcomes scores.

“Activity scores were higher for the isolated [medial patellofemoral ligament] MPFL cohort at early follow-up” Seth L. Sherman, MD, said during his presentation. “Complication profile was similar between both groups.”

Sherman and colleagues retrospectively reviewed prospectively collected data for 87 patients who underwent soft tissue stabilization with MPFL reconstruction for recurrent patellar instability with or without concomitant tibial tubercle osteotomy. There were 31 patients who underwent MPFL reconstruction with tibial tubercle osteotomy and 55 patients underwent MPFL reconstruction without tibial tubercle osteotomy. Investigators collected preoperative and postoperative patient-reported outcomes, such as the KOOS domains, PROMIS, IKDC, SANE and Marx scores. Complications that needed reoperation were recorded.

Results showed no difference in preoperative outcome scores between the treatment groups. Both groups saw significant improvements in all KOOS domains; however, there were no significant differences between them. Significant improvements were seen in SANE, IKDC and PROMIS scores.

At 6 months, the Marx activity score was significantly different between the two groups. Patients who underwent tibial tubercle osteotomy had a Marx activity score of 0.79 vs. 4.61 in patients who underwent MPFL alone. There were four knees who underwent MPFL- tibial tubercle osteotomy that needed additional surgery and six knees in patients who underwent MPFL alone that needed additional surgery. The overall complication and recurrent instability rates were not significantly different in either group. – by Monica Jaramillo

Reference:

Sherman SL, et al. Abstract 62. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.

Disclosure: Sherman reports he has no relevant financial disclosures.

    Perspective
    Laurie Hiemstra

    Laurie Hiemstra

    Medial patellofemoral ligament (MPFL) reconstruction is the benchmark procedure for stabilization of an unstable patella, however the thresholds for adding concomitant procedures, such as a tibial tubercle osteotomy (TTO), are not well defined. Previous studies have demonstrated that isolated MPFL reconstruction results in good clinical outcomes even in the setting of risky pathoanatomic features.

    This retrospective study undertaken by Sherman and colleagues investigated this issue from an alternate perspective. The authors evaluated the outcomes of a consecutive patient cohort comparing isolated MPFL reconstruction with MPFL reconstruction combined with TTO. The selection of the surgical procedures was at the discretion of the fellowship-trained surgeon, following a comprehensive evaluation of the patient including history, physical examination and imaging.

    In this cohort of 95 knees, 38 knees (40%) underwent a TTO in combination with an MPFL reconstruction. Preoperative and postoperative scores assessed with the KOOS, IKDC, SANE and PROMIS outcomes were not different between the groups, with both groups demonstrating significant improvements following surgery. In addition, there were no differences in the rates of complications or failures. The authors noted that the MPFL plus TTO group demonstrated a slower return to sport at 6 months with statistically significantly lower Marx scores than isolated MPFL reconstruction (P=.01).

    This paper demonstrated that the addition of the TTO did not result in inferior outcomes following MPFL reconstruction. Although this study was not designed to define the threshold of when to include a TTO in addition to an MPFL reconstruction, these authors have provided reassuring data to indicate that the addition of the bony procedure is both safe and effective in this patient population.

     

    Reference:

    Erickson BJ et al. Am J Sports Med. 2019; doi:10.1177/0363546519835800.

     

    • Laurie Hiemstra, MD
    • Banff Sports Medicine
      Alberta, Canada

    Disclosures: Hiemstra reports no relevant financial disclosures.

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