Anish Singh
Significant Divergence in Patellar Height Trajectory Post-MPFL Reconstruction: A Comparative Study with and without Tibial Tubercle Osteotomy
Mentor: Justin Ernat, MD, MHA, FAAOS
Department: Orthopedics
Introduction: Patellar instability often leads to recurrent dislocations and compromised knee function. Medial patellofemoral ligament reconstruction (MPFLR) is commonly utilized to restore stability, with tibial tubercle osteotomy (TTO) sometimes added to address bony misalignments of the knee joint. Patellar height, particularly patella alta, is a critical factor in patellofemoral biomechanics and stability. This study’s aim is to compare the impact of MPFLR and MPFLR with TTO (MPFL-TTO) on postoperative patellar height, hypothesizing that MPFLR alone will return closer to preoperative patellar height over time.
Methods: A retrospective review of patients who underwent MPFLR or MPFL-TTO was conducted. Patellar height was measured using the Caton-Deschamps Index (CDI) in the preoperative period and postoperatively at <6-months and >6-months. Propensity score matching and independent t-tests were utilized to compare CDI changes between groups at preoperative, 3-month, and >6-month postoperative intervals.
Results: Ninety-seven patients were included in the analysis. Mean preoperative CDI was 1.17 (±0.18) and 1.18 (±0.17) in the MPFLR and MPFL-TTO groups, respectively (p=0.890). Mean postoperative CDI in MPFLR and MPFL-TTO groups at >6 months was 1.178 (±0.18) and 1.138 (±0.18), respectively (p = 0.497). The mean CDI difference between preoperative and >6 months was -0.014 (±0.126) and -0.090 ± 0.151 in the MPFLR and MPFL-TTO groups, respectively (p = 0.009).
Conclusion: This study indicates that while patellar height initially decreases in both MPFLR and MPFL-TTO, only MPFLR shows a significant return toward preoperative levels after 6 months. The differing postoperative trajectories highlight the need for further research on their clinical implications.
