Evaluation of Differences in Patellar Height After Patellar Stabilization Procedures Not Intended to Address Patella Alta: A Multicenter Study

R Timothy Kreulen; Gregory Anderson; Sercan Yalcin; Joseph M Hart; Kaitlyn Shank; Matthew S Fury; John J Elias; Miho J Tanaka; Lutul D Farrow; David R Diduch; Andrew J Cosgarea

doi:10.1177/23259671241235597

Evaluation of Differences in Patellar Height After Patellar Stabilization Procedures Not Intended to Address Patella Alta: A Multicenter Study

Orthop J Sports Med. 2024 Mar 20;12(3):23259671241235597. doi: 10.1177/23259671241235597. eCollection 2024 Mar.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Johns Hopkins, School of Medicine, Baltimore, Maryland, USA.
² Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
³ Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
⁵ Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Department of Health Sciences, Cleveland Clinic Akron General, Akron, Ohio, USA.

Abstract

Background: Recent studies have reported conflicting results as to whether isolated medial patellofemoral ligament reconstruction (MPFLr) leads to decreased patellar height.

Purpose: To investigate if patellar stabilization surgery not intended to address patella alta influences patellar height.

Study design: Cohort study; Level of evidence, 3.

Methods: A multicenter retrospective chart review was conducted, and patients who underwent MPFLr, medializing tibial tuberosity osteotomy (TTO), and/or trochleoplasty between 2016 and 2020 were included. The Caton-Deschamps index (CDI) was calculated from radiographs obtained preoperatively, 2 weeks postoperatively, and 3 months postoperatively. The preoperative CDI value was compared with the 2-week postoperative and 3-month postoperative values according to stabilization procedure (isolated MPFLr, isolated TTO, MPFLr + TTO, MPFLr + trochleoplasty, and MPFLr + trochleoplasty + TTO) using the paired t test. Analyses of the 1-bundle versus 2-bundle MPFLr technique and the presence of lateral retinacular release or lateral retinacular lengthening were conducted on the isolated MPFLr and combined MPFLr + TTO cohorts.

Results: A total of 356 knees were included. Statistically significant pre- to postoperative decreases in CDI were seen in all stabilization procedures analyzed (P≤ .017 for all). Within the isolated MPFLr cohort, this significant decrease was seen at 2 weeks postoperatively with the 2-bundle technique (ΔCDI = -0.09; P < .001) but not with the 1-bundle technique (ΔCDI = -0.01; P = .621).

Conclusion: The different surgical techniques analyzed in the current study affected patellar height, even when a distalizing TTO was not performed. The decrease was dependent on surgical technique, with a 2-bundle MPFLr leading to a statistically significant decrease and a 1-bundle MPFLr effecting no change.

Keywords: dislocation; patella; patellar stabilization.