Summary

MQTFL reconstruction is a safe and reliable option for patellofemoral stabilization, compared to MPFL reconstruction, both as a stand-alone procedure and in conjunction with other surgeries of the patellofemoral joint.

Abstract

Introduction

This study reports a case series of patients undergoing MQTFL reconstruction for lateral patellar instability, comparing them with patients undergoing MPFL reconstruction.

Methods

From the author’s surgical database 10 MQTFL reconstructions were identified, analyzed, and compared with 20 MPFL reconstructions. Analyzed data included patient demographics and presentation, surgical details, and post-operative outcomes.

Results

The MQTFL and MPFL groups had similar demographics in terms of gender, bilateral presentation, and history of trauma. MQTFL patients were slightly older, had a higher BMI, and were more likely to be involved in athletics or manual labor. MQTFL patients' overall presentation appeared to be more complex, with more patients having prior surgery (40% vs 25%) and specifically previous patellofemoral stabilization (20% vs 10%). MQTFL group was less likely to undergo isolated soft-tissue procedure (20% vs 45%), and more likely to undergo an associated cartilage repair (50% vs 15%). Tibial tubercle osteotomy was performed in 50% of cases in both groups. Neither group had any intra- or peri-operative complications.
At least 6 months of post-operative follow-up was available for 7 MQTFL cases and 18 MPFL cases. Average duration of follow-up was significantly higher in the MPFL group (30 vs 11 months). Good or excellent outcomes were reported in 71% of MQTFL cases and 94% of MPFL cases, with a 100% return to sports/gym or manual labor for those patients who engaged in these activities preoperatively. Re-operation rates were similar (25% vs 19%) and were done for painful hardware, stiffness/adhesions, and cartilage problems. Poor and fair outcomes were noted in patients with history of trauma, pain rather than instability as a main complaint, previous surgery, associated cartilage repair, and recurrent subluxation.

Conclusion

Based on the results from this small case series, MQTFL reconstruction produces comparable results to those of MPFL reconstruction, with low rates of recurrent patellar instability and high rates of return to activities. Re-operation may be necessary in a not insignificant number of patients (up to a 25% in this cohort), to address such issues as painful hardware, joint stiffness, and chondral repair overgrowth.