Jacob D Gorbaty1, Dax T Varkey2, Ian S Hong2,3, David P Trofa4, Susan M Odum3,5, Dana P Piasecki2,3, Bryan M Saltzman6,7, James E Fleischli2,3. 1. Department of Orthopaedic Surgery, Atrium Health, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28207, USA. 2. OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA. 3. Musculoskeletal Institute, Atrium Health, 1320 Scott Ave, Charlotte, NC, 28203, USA. 4. Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, 622 West 168th St, PH 11-1130, New York, NY, 10032, USA. 5. OrthoCarolina Research Institute, 2001 Vail Ave Suite #300, Charlotte, NC, 28207, USA. 6. OrthoCarolina Sports Medicine Center, 1915 Randolph Road, Charlotte, NC, 28207, USA. Bryan.Saltzman@orthocarolina.com. 7. Musculoskeletal Institute, Atrium Health, 1320 Scott Ave, Charlotte, NC, 28203, USA. Bryan.Saltzman@orthocarolina.com.
Abstract
PURPOSE: To determine the reoperation rate, risk factors for reoperation, and patient-reported outcomes after isolated or combined tibial tubercle transfer and medial patellofemoral ligament reconstruction, for patellofemoral instability surgery. METHODS: Patient's records who underwent medial patellofemoral ligament reconstruction and/or tibial tubercle transfer for patellar instability by 35 surgeons from 2002 to 2018 at a single academic institution were retrospectively reviewed using CPT codes. Four-hundred-and-eighty-six patients were identified. Radiographic measurements, demographic parameters, and subsequent revision procedures and their indications were identified. A modified anterior knee pain survey was conducted by mail and with follow-up phone survey. RESULTS: The overall rate of reoperation was 120/486 (24.7%). The most common cause for reoperation was removal of hardware 42/486 (8.6%). The rate of reoperation for isolated medial patellofemoral ligament reconstruction 43/226 (19%) was lower than that of isolated tibial tubercle transfer 45/133 (33.8%) or a combined procedure 32/127 (25.2%) (P = 0.007). Woman had a higher rate of reoperation (29.4%) compared to men (15.9%) (P = 0.002). Patients at risk for a revision stabilization procedure included those with severe trochlear morphology (C or D) (6.1%) and those with Caton-Deschamps index > 1.3 (7.3%). Patients who underwent reoperation of any kind had poorer patient-reported outcomes. CONCLUSION: The overall reoperation rate after patellofemoral instability surgery remains high, and any reoperation portends worse patient-reported outcomes. Re-operations for instability are more likely in patients with trochlear dysplasia and patella alta and may benefit from more aggressive initial treatment, such as medial patellofemoral ligament reconstruction and tibial tubercle transfer in combination. Using the results of this study, surgeons will be able to engage in meaningful discussion with patients to counsel patients on expectations postoperatively. LEVEL OF EVIDENCE: IV.
PURPOSE: To determine the reoperation rate, risk factors for reoperation, and patient-reported outcomes after isolated or combined tibial tubercle transfer and medial patellofemoral ligament reconstruction, for patellofemoral instability surgery. METHODS: Patient's records who underwent medial patellofemoral ligament reconstruction and/or tibial tubercle transfer for patellar instability by 35 surgeons from 2002 to 2018 at a single academic institution were retrospectively reviewed using CPT codes. Four-hundred-and-eighty-six patients were identified. Radiographic measurements, demographic parameters, and subsequent revision procedures and their indications were identified. A modified anterior knee pain survey was conducted by mail and with follow-up phone survey. RESULTS: The overall rate of reoperation was 120/486 (24.7%). The most common cause for reoperation was removal of hardware 42/486 (8.6%). The rate of reoperation for isolated medial patellofemoral ligament reconstruction 43/226 (19%) was lower than that of isolated tibial tubercle transfer 45/133 (33.8%) or a combined procedure 32/127 (25.2%) (P = 0.007). Woman had a higher rate of reoperation (29.4%) compared to men (15.9%) (P = 0.002). Patients at risk for a revision stabilization procedure included those with severe trochlear morphology (C or D) (6.1%) and those with Caton-Deschamps index > 1.3 (7.3%). Patients who underwent reoperation of any kind had poorer patient-reported outcomes. CONCLUSION: The overall reoperation rate after patellofemoral instability surgery remains high, and any reoperation portends worse patient-reported outcomes. Re-operations for instability are more likely in patients with trochlear dysplasia and patella alta and may benefit from more aggressive initial treatment, such as medial patellofemoral ligament reconstruction and tibial tubercle transfer in combination. Using the results of this study, surgeons will be able to engage in meaningful discussion with patients to counsel patients on expectations postoperatively. LEVEL OF EVIDENCE: IV.
Authors: Bryan M Saltzman; Allison Rao; Brandon J Erickson; Gregory L Cvetanovich; David Levy; Bernard R Bach; Brian J Cole Journal: Am J Orthop (Belle Mead NJ) Date: 2017 Nov/Dec
Authors: Avinesh Agarwalla; Anirudh K Gowd; Joseph N Liu; Richard N Puzzitiello; Adam B Yanke; Nikhil N Verma; Brian Forsythe Journal: Orthop J Sports Med Date: 2019-04-12