Combined Reconstruction of the Medial Patellofemoral and Medial Patellotibial Ligaments: Outcomes and Prognostic Factors

Purpose: To report outcomes after combined reconstruction of medial patellofemoral ligament (MPFL) & medial patellotibial ligament (MPTL) and test associations between prognostic factors and clinical outcomes. It was hypothesized that combined MPFL & MPTL reconstruction would result in significant improvements in function, and that outcomes would be associated with age, sex, Beighton score, concomitant articular lesions, and preoperative function.

Methods: All combined reconstructions of MPFL & MPTL were reviewed. Inclusion criterion was minimum 2-year follow-up. Exclusion criteria were age at surgery≥35 years and concomitant osteotomies. Kujala, Tegner and Marx scores were collected prospectively. Patients were evaluated at minimum 2-year follow-up. Associations between potential prognostic factors versus Kujala and Tegner scores were tested using bivariate analyses followed by multivariate regression models.

Results: Of 22 patients (26 knees), 19 (23 knees) met inclusion criteria, and 16 (20 knees) were available for follow-up. Mean age at surgery 18 years (range, 14.5-23). Mean follow-up 43 months (range, 24-73). Kujala score improved significantly compared to before surgery (86.4±12.5 vs. 54.9±15.2, p<0.01). Tegner level at follow-up was nonsignificant higher compared to before surgery (4.8±2.4 vs. 4±3, p=ns) and lower compared to before first patella dislocation (4.8±2.4 vs. 5.9 ±1.2, p<0.01). Latest Kujala was associated with male sex (p=0.02), with medial patellofemoral chondral lesions (p=0.01) and with preoperative Kujala score (p=0.05), while multivariate regression showed medial patellofemoral lesions had the largest impact on this outcome (adjusted r²=0.27 for patellofemoral lesions versus adjusted r²=0.33 with all 3 factors included). Latest Tegner level was associated with male sex (p<0.01), with preoperative Tegner level (p<0.01), and with Beighton score (p<0.01), while multivariate regression incorporating these 3 predictors showed adjusted r²=0.85 where only preoperative Tegner level and Beighton score remained consistent predictors of outcome. Patella apprehension was recorded in 2 knees (10%) in 2 patients.

Conclusion: Combined reconstruction of the MPFL & MPTL in young adults is effective and results in significant improvements in subjective knee function with minimal risks, although preinjury activity levels are not consistently restored. Improved function is associated particularly with higher preoperative knee scores and activity levels, with medial patellofemoral chondral lesions, and with decreased Beighton scores.