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DOI: 10.1055/s-0043-1770156
Short-Term Outcomes of Concomitant Patellofemoral Arthroplasty and Medial Patellofemoral Ligament Reconstruction to Treat Concurrent Patellofemoral Arthritis and Patellar Instability
Funding None.![](https://www.thieme-connect.de/media/jks/202405/lookinside/thumbnails/10-1055-s-0043-1770156_22jun0083oa-1.jpg)
Abstract
The purpose of this study was to evaluate the efficacy of combined patellofemoral arthroplasty (PFA) and medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral arthritis in the setting of concomitant patellar instability. Patients who underwent single-stage, combined PFA and MPFL reconstruction by a single surgeon at a tertiary-care orthopaedic center between 2016 and 2021 were identified. Postoperative radiographic and clinical outcomes at a minimum of 6 months were recorded using patient-reported outcome measures, including International Knee Documentation Committee (IKDC), Kujala, and VR-12. Early complications and rates of recurrent instability were also recorded. Of the 16 patients who met inclusion and exclusion criteria, 13 patients were available for final follow-up (81%; 51.7 ± 7.2 years, 11 females, 2 males) with a mean clinical follow-up of 1.3 ± 0.5 years (range: 0.5–2.3 years). Patients experienced significant improvements in patellar tilt and multiple patient-reported outcome metrics postoperatively, including IKDC, Kujala, VR-12 Mental Health, and VR-12 Physical Health. At the time of the most recent follow-up, no patient had experienced a postoperative dislocation or subluxation event. The findings suggest that concurrent PFA and MPFL reconstruction are associated with significant improvements in multiple patient-reported outcomes. Further studies are needed to evaluate the duration of clinical benefits achieved with this combined intervention.
Keywords
patellofemoral arthroplasty - osteoarthritis - knee arthroplasty - medial patellofemoral ligament reconstruction - patient-reported outcomes - patellaPublication History
Received: 15 June 2022
Accepted: 12 May 2023
Article published online:
20 June 2023
© 2023. Thieme. All rights reserved.
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References
- 1 Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM. The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res 2002; (402) 206-212
- 2 Stefanik JJ, Niu J, Gross KD, Roemer FW, Guermazi A, Felson DT. Using magnetic resonance imaging to determine the compartmental prevalence of knee joint structural damage. Osteoarthritis Cartilage 2013; 21 (05) 695-699
- 3 Strickland SM, Bird ML, Christ AB. Advances in patellofemoral arthroplasty. Curr Rev Musculoskelet Med 2018; 11 (02) 221-230
- 4 Walker T, Perkinson B, Mihalko WM. Patellofemoral arthroplasty: the other unicompartmental knee replacement. J Bone Joint Surg Am 2012; 94 (18) 1712-1720
- 5 Ajnin S, Buchanan D, Arbuthnot J, Fernandes R. Patellofemoral joint replacement—mean five year follow-up. Knee 2018; 25 (06) 1272-1277
- 6 Imhoff AB, Feucht MJ, Bartsch E, Cotic M, Pogorzelski J. High patient satisfaction with significant improvement in knee function and pain relief after mid-term follow-up in patients with isolated patellofemoral inlay arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27 (07) 2251-2258
- 7 Odgaard A, Madsen F, Kristensen PW, Kappel A, Fabrin J. The Mark Coventry Award: patellofemoral arthroplasty results in better range of movement and early patient-reported outcomes than TKA. Clin Orthop Relat Res 2018; 476 (01) 87-100
- 8 Fredborg C, Odgaard A, Sørensen J. Patellofemoral arthroplasty is cheaper and more effective in the short term than total knee arthroplasty for isolated patellofemoral osteoarthritis: cost-effectiveness analysis based on a randomized trial. Bone Joint J 2020; 102-B (04) 449-457
- 9 van der List JP, Chawla H, Villa JC, Pearle AD. Why do patellofemoral arthroplasties fail today? A systematic review. Knee 2017; 24 (01) 2-8
- 10 Fithian DC, Paxton EW, Stone ML. et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (05) 1114-1121
- 11 Hsiao M, Owens BD, Burks R, Sturdivant RX, Cameron KL. Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Am J Sports Med 2010; 38 (10) 1997-2004
- 12 Hiemstra LA, Kerslake S, Lafave M. Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3849-3855
- 13 Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. [Patella infera. Apropos of 128 cases]. Rev Chir Orthop Repar Appar Mot 1982; 68 (05) 317-325
- 14 Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 1974; 56 (07) 1391-1396
- 15 Grelsamer RP, Bazos AN, Proctor CS. Radiographic analysis of patellar tilt. J Bone Joint Surg Br 1993; 75 (05) 822-824
- 16 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
- 17 Sperner G, Wanitschek P, Benedetto KP, Glötzer W. [Late results in patellar fracture]. Aktuelle Traumatol 1990; 20 (01) 24-28
- 18 Lippacher S, Dejour D, Elsharkawi M. et al. Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 2012; 40 (04) 837-843
- 19 Schoettle PB, Zanetti M, Seifert B, Pfirrmann CWA, Fucentese SF, Romero J. The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 2006; 13 (01) 26-31
- 20 Jeong SH, Schneider B, Pyne AS, Tishelman JC, Strickland SM. Patellofemoral arthroplasty surgical technique: lateral or medial parapatellar approach. J Arthroplasty 2020; 35 (09) 2429-2434
- 21 Liu JN, Brady JM, Kalbian IL. et al. Clinical outcomes after isolated medial patellofemoral ligament reconstruction for patellar instability among patients with trochlear dysplasia. Am J Sports Med 2018; 46 (04) 883-889
- 22 Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy 1993; 9 (02) 159-163
- 23 Hefti F, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1 (3-4): 226-234
- 24 Selim AJ, Rogers W, Fleishman JA. et al. Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Qual Life Res 2009; 18 (01) 43-52
- 25 van Jonbergen H-PW, Werkman DM, van Kampen A. Conversion of patellofemoral arthroplasty to total knee arthroplasty: a matched case-control study of 13 patients. Acta Orthop 2009; 80 (01) 62-66
- 26 Pogorzelski J, Rupp M-C, Ketzer C. et al. Reliable improvements in participation in low-impact sports following implantation of a patellofemoral inlay arthroplasty at mid-term follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29 (10) 3392-3399
- 27 Lonner JH. Patellofemoral arthroplasty: an evolving science. Instr Course Lect 2017; 66: 211-221
- 28 Sanders TL, Pareek A, Johnson NR, Stuart MJ, Dahm DL, Krych AJ. Patellofemoral arthritis after lateral patellar dislocation: a matched population-based analysis. Am J Sports Med 2017; 45 (05) 1012-1017 DOI: 10.1177/0363546516680604.
- 29 Yang G, Wang J, Dai Y, Lin W, Niu J, Wang F. Patellofemoral arthroplasty improves patellofemoral alignment in patients with patellofemoral osteoarthritis with trochlear dysplasia. J Knee Surg 2020; 35 (03) 331-336