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.
A retrospective matched-cohort study was conducted involving patients who underwent MQTFLR or MPFLR with or without tibial tubercle osteotomy (TTO) from 2019-2021. 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.
Ten MQTFLR and ten MPFLR patients were included in the study. The MQTFLR and MPFLR cohorts did not differ significantly in age (MQTFLR mean 28.7 years, MPFLR mean 29.1 years, p = 0.74) or gender (MQTFLR 80% female, MPFLR 90% female). Follow-up time was longer in the MPFLR group though not significantly so (MQTFLR mean 19.7 months, MPFLR mean 28.3 months, p = 0.06). In each group, six patients underwent concomitant TTO and seven patients underwent concomitant patellar OCA. 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). Although the passing rate on the MPFL-RSI was higher in the MQTFLR cohort (MQTFLR 75% vs MPFLR 38%), this difference did not reach statistical significance (p = 0.31).
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.