Medial quadriceps tendon femoral ligament reconstruction and medial patellofemoral ligament reconstruction have no significant differences in clinical outcomes for treatment of lateral patellar instability: a matched-cohort study

Dhruv S Shankar; Brittany DeClouette; Amanda Avila; Kinjal D Vasavada; Rae Lan; Eric J Strauss; Laith M Jazrawi; Michael J Alaia; Guillem Gonzalez-Lomas; Kirk A Campbell

doi:10.1016/j.jisako.2024.03.008

Medial quadriceps tendon femoral ligament reconstruction and medial patellofemoral ligament reconstruction have no significant differences in clinical outcomes for treatment of lateral patellar instability: a matched-cohort study

J ISAKOS. 2024 Mar 14:S2059-7754(24)00053-1. doi: 10.1016/j.jisako.2024.03.008. Online ahead of print.

Affiliations

¹ Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, 4th Floor, New York, NY, 10016, USA.
² Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, 333 East 38th St, 4th Floor, New York, NY, 10016, USA. Electronic address: kirk.campbell@nyulangone.org.

PMID: 38490437
DOI: 10.1016/j.jisako.2024.03.008

Abstract

Objectives: The purpose of this study was to compare clinical outcomes of medial quadriceps tendon-femoral ligament reconstruction (MQTFLR) and medial patellofemoral ligament reconstruction (MPFLR) among patients with recurrent lateral patellar instability.

Methods: A retrospective matched-cohort study was conducted involving patients who underwent MQTFLR or MPFLR with or without tibial tubercle osteotomy (TTO) from 2019 to 2021. Subjects were matched 1:1 on age, concomitant osteochondral allograft (OCA), concomitant TTO, and follow-up time. Measured outcomes included 90-day complications, Visual Analog Scale (VAS) knee pain, return to sport/work, Kujala score, Tegner score, and MPFL-Return to Sport after Injury (MPFL-RSI) score. Outcomes were compared between groups using Mann-Whitney U-test for continuous variables and Fisher's exact test for categorical variables. P-values <0.05 were considered significant.

Results: Ten MQTFLR patients (mean age 28.7 years, 80% female, mean follow-up 19.7 months) and ten MPFLR patients (mean age 29.1 years, 90% female, mean follow-up 28.3 months) were included in the study. One MQTFLR patient (10%) and three MPFLR patients (30%) underwent reoperation for postoperative arthrofibrosis. Postoperative VAS resting pain was not significantly different between the groups (MQTFLR mean 1.1, MPFLR mean 0.6, p = 0.31). There were no significant differences in rates of recurrent subluxations (MQTFLR 20%, MPFLR 0%, p = 0.47), return to sport (MQTFLR 50%, MPFLR 75%, p = 0.61), return to work (MQTFLR 100%, MPFLR 88%, p = 1.00), or MPFL-RSI pass rate (MQTFLR 75% vs. MPFLR 38%, p = 0.31).

Conclusion: There were no significant differences in knee pain and function, return to work, and rates of recurrent patellar instability between patients who underwent MQTFLR versus MPFLR, though these results should be interpreted with caution given the small sample size and potential selection bias.

Level of evidence: III.

Keywords: Medial patellofemoral ligament; Medial quadriceps tendon-femoral ligament; Patellar instability; Return to sport; Return to work; Tibial tubercle osteotomy.