Patient-Reported Outcomes After Revision Surgery for Failed Medial Patellofemoral Ligament Reconstruction: A Matched-Pair Analysis Including Correction of Predisposing Factors

Background: Complications and the need for revision surgery after medial patellofemoral ligament reconstruction (MPFLR) are evident in the current literature. However, there is a shortage of clinical data evaluating the results of revision surgery in individual patients after failed MPFLR. Purpose: To investigate the results of tailored revision surgery for failed MPFLR, including the correction of predisposing factors. Study Design: Cohort study; Level of evidence, 3. Methods: Between August 2015 and March 2019, 25 patients (male:female, n = 9:16; mean ± SD age, 25.9 ± 6.5 years) underwent revision surgery for failed MPFLR (study group). The Banff Patella Instability Instrument 2.0 (BPII 2.0) and a numerical analog scale (0-10) for patellofemoral pain and subjective knee joint function were used to assess patient-reported quality of life before and after revision surgery. The control group of 50 patients (male:female, n = 18:32; age, 22.8 ± 4.3 years) who underwent identical patellar-stabilizing procedures was matched 1:2 by the surgical procedure, predisposing factors, sex, age, and follow-up time. Results: Evaluation was performed postoperatively at a mean 27.8 ± 14.0 months (range, 12-54 months) in the study group and 26.1 ± 11.2 months (range, 12-56 months) in the control group (P = .55). The BPII 2.0 score increased from 28.6 ± 17.9 points to 68.7 ± 22.3 points (P < .0001) in the study group and from 43.8 ± 22.5 points to 75.5 ± 21.4 points (P < .0001) in the control group from preoperatively to postoperatively, respectively. Before revision surgery, the BPII 2.0 scores in the study group were significantly inferior to those in the control group (P = .0026). At the final follow-up, the BPII 2.0 score in the study group was not significantly lower (P = .174), and a similar number of patients in the study group and the control group achieved the minimally clinically important difference (P = .49). Patellofemoral pain and subjective knee joint function improved significantly in both groups (P < .0001, P < .0001), without any significant difference between them at the final follow-up (P = .85, P = .86). Conclusion: Revision surgery for MPFLR failure, including the correction of major anatomic risk factors, yielded a significant improvement in patient-reported quality-of-life outcome measures. Patients with failed MPFLR, however, were significantly more restricted before revision surgery than patients without previous interventions when evaluated with the BPII 2.0.

[1]  S. Zaffagnini,et al.  Recurrent patellar dislocations without untreated predisposing factors: MPFL reconstruction vs other medial soft tissue surgical techniques - A meta-analysis. , 2020, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[2]  S. Maher,et al.  Medial Patellofemoral Ligament Isometry in the Setting of Patella Alta. , 2017, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  L. Hiemstra,et al.  Relationship between Anatomical Risk Factors, Articular Cartilage Lesions, and Patient Outcomes Following Medial Patellofemoral Ligament Reconstruction , 2019, Cartilage.

[4]  Hui Zhang,et al.  Increased femoral anteversion is associated with inferior clinical outcomes after MPFL reconstruction and combined tibial tubercle osteotomy for the treatment of recurrent patellar instability , 2019, Knee Surgery, Sports Traumatology, Arthroscopy.

[5]  Jin Zhang,et al.  A High-Grade J Sign Is More Likely to Yield Higher Postoperative Patellar Laxity and Residual Maltracking in Patients With Recurrent Patellar Dislocation Treated With Derotational Distal Femoral Osteotomy , 2019, The American journal of sports medicine.

[6]  L. Hiemstra,et al.  Influence of Risky Pathoanatomy and Demographic Factors on Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction: A Regression Analysis , 2019, The American journal of sports medicine.

[7]  P. O'loughlin,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 , 2019, The American journal of sports medicine.

[8]  B. Erickson,et al.  Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of Tibial Tubercle–Trochlear Groove Distance and Patellar Height: Outcomes at 1 and 2 Years , 2019, The American journal of sports medicine.

[9]  P. Balcarek,et al.  Geometry of Torsional Malalignment Syndrome: Trochlear Dysplasia but Not Torsion Predicts Lateral Patellar Instability , 2019, Orthopaedic journal of sports medicine.

[10]  Christopher L. Camp,et al.  The Recurrent Instability of the Patella Score: A Statistically Based Model for Prediction of Long-Term Recurrence Risk After First-Time Dislocation. , 2019, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[11]  R. Abdalla,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. , 2019, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[12]  J. Agel,et al.  Risk of Redislocation After Primary Patellar Dislocation: A Clinical Prediction Model Based on Magnetic Resonance Imaging Variables , 2018, The American journal of sports medicine.

[13]  M. Liebensteiner,et al.  The reversed dynamic patellar apprehension test mimics anatomical complexity in lateral patellar instability , 2018, Knee Surgery, Sports Traumatology, Arthroscopy.

[14]  K. Frosch,et al.  Clinical Results after Combined Distal Femoral Osteotomy in Patients with Patellar Maltracking and Recurrent Dislocations , 2018, The Journal of Knee Surgery.

[15]  G. Pagenstert,et al.  Does patella alta lead to worse clinical outcome in patients who undergo isolated medial patellofemoral ligament reconstruction? A systematic review , 2018, Archives of Orthopaedic and Trauma Surgery.

[16]  W. Post,et al.  Patellofemoral Instability: A Consensus Statement From the AOSSM/PFF Patellofemoral Instability Workshop , 2018, Orthopaedic journal of sports medicine.

[17]  P. Schöttle,et al.  Successful adaption of the Banff Patella Instability Instrument (BPII) 2.0 into German , 2018, Knee Surgery, Sports Traumatology, Arthroscopy.

[18]  M. Lind,et al.  Clinical outcomes after revision surgery for medial patellofemoral ligament reconstruction , 2018, Knee Surgery, Sports Traumatology, Arthroscopy.

[19]  B. Stein,et al.  Medial Patellofemoral Ligament Isometry in the setting of Patella Alta , 2017, Orthopaedic Journal of Sports Medicine.

[20]  C. Franciozi,et al.  Increased Femoral Anteversion Influence Over Surgically Treated Recurrent Patellar Instability Patients. , 2017, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[21]  T. Friede,et al.  Results of medial patellofemoral ligament reconstruction compared with trochleoplasty plus individual extensor apparatus balancing in patellar instability caused by severe trochlear dysplasia: a systematic review and meta-analysis , 2017, Knee Surgery, Sports Traumatology, Arthroscopy.

[22]  L. Hiemstra,et al.  Factor Analysis and Item Reduction of the Banff Patella Instability Instrument (BPII) , 2016, The American journal of sports medicine.

[23]  L. Hiemstra,et al.  Effect of Trochlear Dysplasia on Outcomes After Isolated Soft Tissue Stabilization for Patellar Instability , 2016, The American journal of sports medicine.

[24]  G. Myer,et al.  Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for the Treatment of Recurrent Lateral Patellar Dislocations , 2016, The American journal of sports medicine.

[25]  N. Friederich,et al.  Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review , 2017, Knee Surgery, Sports Traumatology, Arthroscopy.

[26]  S. Horibe,et al.  Factors Affecting the Outcomes of Double-Bundle Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations Evaluated by Multivariate Analysis , 2015, The American journal of sports medicine.

[27]  T. Walde,et al.  Accuracy of Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction , 2015, The American journal of sports medicine.

[28]  J. Henckel,et al.  Computed tomography scanogram compared to long leg radiograph for determining axial knee alignment , 2015, Acta orthopaedica.

[29]  Beth E Shubin Stein,et al.  Widespread Implementation of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Maintains Functional Outcomes at Midterm to Long-Term Follow-up While Decreasing Complication Rates: A Systematic Review. , 2015, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[30]  N. Parsons,et al.  Medial Patellofemoral Ligament Reconstruction for Patellar Dislocation , 2014, Orthopaedic journal of sports medicine.

[31]  H. Reichel,et al.  Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients , 2014, International Orthopaedics.

[32]  Sean Williams,et al.  Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft. , 2014, Arthroscopy techniques.

[33]  T. Matsushita,et al.  Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity–trochlear groove distance , 2014, Knee Surgery, Sports Traumatology, Arthroscopy.

[34]  C. Walker,et al.  Does Degree of Trochlear Dysplasia and Position of Femoral Tunnel Influence Outcome After Medial Patellofemoral Ligament Reconstruction? , 2014, The American journal of sports medicine.

[35]  K. Stürmer,et al.  Which patellae are likely to redislocate? , 2014, Knee Surgery, Sports Traumatology, Arthroscopy.

[36]  S. Hinterwimmer,et al.  Anatomical two-bundle medial patellofemoral ligament reconstruction with hardware-free patellar graft fixation: technical note and preliminary results , 2013, Knee Surgery, Sports Traumatology, Arthroscopy.

[37]  S. Parikh,et al.  Complications of Medial Patellofemoral Ligament Reconstruction in Young Patients , 2013, The American journal of sports medicine.

[38]  G. Bauer,et al.  The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon , 2013, Knee Surgery, Sports Traumatology, Arthroscopy.

[39]  D. Flanigan,et al.  A Systematic Review of Complications and Failures Associated With Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation , 2012, The American journal of sports medicine.

[40]  L. Labey,et al.  Tibial Tubercle–Posterior Cruciate Ligament Distance , 2012, The American journal of sports medicine.

[41]  P. Neyret,et al.  In Vivo Positioning Analysis of Medial Patellofemoral Ligament Reconstruction , 2011, The American journal of sports medicine.

[42]  J. Nyland,et al.  Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[43]  D. Dejour,et al.  Osteotomies in Patello-Femoral Instabilities , 2007, Sports medicine and arthroscopy review.

[44]  F. von Knoch,et al.  Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. , 2006, The Journal of bone and joint surgery. British volume.