Trans-osseous tunnel fixation showed better or similar clinical resullts compared with suture anchor fixation for medial patellofemoral ligament reconstruction, however, it also showed more complications such as patella fracture, patellofemoral OA progression.
This study aimed to compare the clinical and radiologic outcomes and complications of medial patellofemoral reconstruction (MPFLR) using the trans-osseous tunnel (TO) versus suture anchor (SA) fixation.
Patients who underwent MPFLR for recurrent patellar dislocations were retrospectively reviewed: 21 (mean age, 24.4 ± 6.1 years) using TO fixation and 25 (mean age, 24.1 ± 12.1 years) using SA fixation. Clinical evaluation findings (International Knee Documentation Committee [IKDC] subjective score, Lysholm score, Tegner activity score), radiologic evaluation findings (congruence angle, patellar tilt angle), and complications (re-dislocation, patella fracture, patellofemoral osteoarthritis progression, infection, stiffness) were compared at 2-year follow-up.
At 2-year follow-up, mean IKDC subjective scores (TO, 83.2 ± 10.8; SA, 86.6 ± 10.0; p = 0.284) and Lysholm scores (TO, 83.1 ± 12.6; SA, 89.3 ± 10.9; p = 0.090) did not significantly differ between groups. Tegner activity score (TO, 5.8 ± 1.4; SA, 4.9 ± 1.2; p = 0.012) was significantly higher in the TO group. Congruence angle (TO, -3.2 ± 22.8; SA, -7.6 ± 17.8; p = 0.464) did not differ significantly between groups. Patella tilt angle (TO, 10.5 ± 5.4; SA, 13.7 ± 2.8; p = 0.015) was better in the TO group. One re-dislocation and 2 patellar fractures (9.5%) occurred in the TO group versus no complications in the SA group. There was a significant difference in patellofemoral OA progression (Kellgren-Lawrence grade) at 2-year follow-up. Patellofemoral OA progression was observed in 9 and 2 patients of the TO and SA groups, respectively, at 2-year follow-up.
TO and SA for MPFLR showed improved clinical and radiological outcomes. Tegner activity score and patella tilt angle results were better in the TO group. However, the TO group showed more complications. These results should be considered in the planning of MPFLR for recurrent patellar dislocations.