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Combined quadriceps medial patellofemoral ligament reconstruction and osteochondral fixation offers good patient-reported outcomes and low rates of recurrent instability for osteochondral defects secondary to acute patella dislocation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Chondral injuries secondary to traumatic patella dislocation are common, and a subgroup of these are significant defects with fragments amenable to fixation. There is a paucity of published evidence assessing patients managed with combined acute patellofemoral stabilisation and osteochondral fixation. The purpose of this study is to report the outcomes of patients with osteochondral injuries secondary to acute traumatic patella dislocation treated with combined early fragment fixation and MPFL reconstruction using a quadriceps tendon turndown technique which has distinct advantages for this cohort, including preventing chondral overloading and non-violation of the patella bone.

Methods

Patients who underwent combined quadriceps tendon MPFL reconstruction and osteochondral fixation were included. Patient demographics, defect characteristics, complications and reoperations were evaluated. Patients were assessed with Lysholm, Kujala, KOOS-PF scores and satisfaction scale at follow up. Pre-operative MRI was assessed for presence of radiological risk factors for patella dislocation and post-operative MRI was used to assess cartilage quality with MOCART 2.0 score.

Results

A total of 19 patients (63.2% female) were included. The mean age was 17.4 ± 4.8 years and patients were followed up at a mean 15.8 ± 5.1 months post-surgery. The mean defect size was 2.4 cm2 ± 1.3 cm2, with the most common defect location being the patella (13/19; 68.4%) followed by the lateral femoral condyle (5/19; 26.3%). At final follow up, the overall mean Lysholm, Kujala, and KOOS-PF scores were 84.9 ± 11.1, 89.7 ± 5.8 and 80.6 ± 13.6, respectively. Seventeen patients (89.5%) were satisfied with their outcome. The mean MOCART 2.0 score at final follow-up was 72.5. One patient required medial capsular plication with removal of a loose chondral body and microfracture and 3 knees required minor reoperations.

Conclusion

Combined acute osteochondral fragment fixation and MPFL reconstruction using a quadriceps tendon graft offers good radiological and patient-reported outcomes with high satisfaction and low rates of recurrent patella dislocation. To our knowledge, this is currently the largest series of its kind in the literature and the results of this study provide a rationale for a combined approach using a quadriceps tendon graft for this cohort.

Level of evidence

Level IV.

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Data availability

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.

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Funding

No funding was received for the present study.

Author information

Authors and Affiliations

  1. Orthopaedic Research Foundation of Western Australia, Perth, Australia

    John P. Scanlon, Antony C. Raymond, Randeep S. Aujla, Satyen Gohil, Jay R. Ebert, Li-On Lam, Shahbaz S. Malik, Ashley Simpson & Peter D’Alessandro

  2. Fiona Stanley Fremantle Hospitals Group, Perth, Australia

    John P. Scanlon, Satyen Gohil, Li-On Lam, Jacobus H. Otto, Declan Neeson & Peter D’Alessandro

  3. University Hospitals Dorset NHS Foundation Trust, Poole, UK

    Antony C. Raymond

  4. University Hospitals of Leicester NHS Trust, Leicester, UK

    Randeep S. Aujla

  5. School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia

    Jay R. Ebert

  6. Worcester Acute Hospitals NHS Trust, Worcester, UK

    Shahbaz S. Malik

  7. Medical School, Division of Surgery, University of Western Australia, Perth, Australia

    Peter D’Alessandro

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  1. John P. Scanlon
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Contributions

JS: study design, data collection, data analysis, drafted the manuscript. AR: data collection, study design, manuscript preparation. RA: data analysis, study design, manuscript preparation. SG: data acquisition, study design. JE: study design, manuscript preparation. LL: data acquisition. SM: manuscript preparation. AS: data collection, data analysis. JO and DN: MRI interpretation and data acquisition. PD: study design, coordination, data acquisition, manuscript preparation.

Corresponding author

Correspondence to John P. Scanlon.

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Conflict of interest

The Orthopaedic Research Foundation of Western Australia receives institutional support from Smith and Nephew and Peter D’Alessandro reported to be a paid consultant for Smith and Nephew. The other authors report no actual or potential conflict of interest in relation to this article.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was acquired from every subject prior to study inclusion.

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Scanlon, J.P., Raymond, A.C., Aujla, R.S. et al. Combined quadriceps medial patellofemoral ligament reconstruction and osteochondral fixation offers good patient-reported outcomes and low rates of recurrent instability for osteochondral defects secondary to acute patella dislocation. Knee Surg Sports Traumatol Arthrosc 31, 4007–4015 (2023). https://doi.org/10.1007/s00167-023-07430-y

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