Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone
Purpose: To use a large nationwide administrative database to directly compare usage, complications, and need for revision stabilization surgery after medial patellofemoral ligament reconstruction (MPLFR), tibial tubercle osteotomy (TTO), and combined MPFLR and TTO (MPFLRTTO). Methods: The PearlDive...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-12-01
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| Series: | Arthroscopy, Sports Medicine, and Rehabilitation |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666061X24001317 |
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| author | Alexander R. Markes, M.D. Ramesh B. Ghanta, M.D. Alan L. Zhang, M.D. C.Benjamin Ma, M.D. Brian T. Feeley, M.D. Drew A. Lansdown, M.D. |
| author_facet | Alexander R. Markes, M.D. Ramesh B. Ghanta, M.D. Alan L. Zhang, M.D. C.Benjamin Ma, M.D. Brian T. Feeley, M.D. Drew A. Lansdown, M.D. |
| author_sort | Alexander R. Markes, M.D. |
| collection | DOAJ |
| description | Purpose: To use a large nationwide administrative database to directly compare usage, complications, and need for revision stabilization surgery after medial patellofemoral ligament reconstruction (MPLFR), tibial tubercle osteotomy (TTO), and combined MPFLR and TTO (MPFLRTTO). Methods: The PearlDiver Mariner database was queried for all reported cases of MPLFR, TTO, and combined MPFLRTTO performed between 2010 and 2020 using Current Procedural Terminology codes. Subsets from those cohorts with laterality-specific International Classification of Diseases, Tenth Revision, codes for patellar instability were used to evaluate 2-year incidence of infection, stiffness, fracture, and revision stabilization with MPFLR and/or TTO. Multiple linear regression and χ2 analysis were used to analyze incidence trends and to compare complication rates. Results: A total of 70,070 patients were identified. MPFLR was found to be the most common procedure (73.1%), followed by TTO (19.2%) and then MPFLRTTO (7.6%). MPLFR was observed to have the lowest overall complication rate (5.4%), whereas both TTO (7.5%) and MPFLRTTO (7.1%) had greater complication rates (P < .001). MPFLR had the greatest rate of revision stabilization surgery at 3.7% compared with TTO at 2.7% and MPFLRTTO, which carried the lowest risk for revision at 2.4% (P < .001). Conclusions: Isolated MPFLR is the most common modality used for patellar instability, with increasing prevalence and the lowest 2-year complication rate. Isolated TTO was unchanged in its use and had the greatest overall complication rate. Combined MPFLRTTO increased the overall complication rate but had a lower 2-year rate of recurrent instability requiring revision than MPFLR alone. Level of Evidence: Level III, retrospective cohort study. |
| format | Article |
| id | doaj-art-e371abb87b574f548586ffa3a35d8a76 |
| institution | DOAJ |
| issn | 2666-061X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroscopy, Sports Medicine, and Rehabilitation |
| spelling | doaj-art-e371abb87b574f548586ffa3a35d8a762025-08-20T02:39:28ZengElsevierArthroscopy, Sports Medicine, and Rehabilitation2666-061X2024-12-016610099410.1016/j.asmr.2024.100994Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure AloneAlexander R. Markes, M.D.0Ramesh B. Ghanta, M.D.1Alan L. Zhang, M.D.2C.Benjamin Ma, M.D.3Brian T. Feeley, M.D.4Drew A. Lansdown, M.D.5Address correspondence to Alexander R. Markes, M.D., 1500 Owens St., San Francisco, California, 94158, U.S.A.; Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A.Purpose: To use a large nationwide administrative database to directly compare usage, complications, and need for revision stabilization surgery after medial patellofemoral ligament reconstruction (MPLFR), tibial tubercle osteotomy (TTO), and combined MPFLR and TTO (MPFLRTTO). Methods: The PearlDiver Mariner database was queried for all reported cases of MPLFR, TTO, and combined MPFLRTTO performed between 2010 and 2020 using Current Procedural Terminology codes. Subsets from those cohorts with laterality-specific International Classification of Diseases, Tenth Revision, codes for patellar instability were used to evaluate 2-year incidence of infection, stiffness, fracture, and revision stabilization with MPFLR and/or TTO. Multiple linear regression and χ2 analysis were used to analyze incidence trends and to compare complication rates. Results: A total of 70,070 patients were identified. MPFLR was found to be the most common procedure (73.1%), followed by TTO (19.2%) and then MPFLRTTO (7.6%). MPLFR was observed to have the lowest overall complication rate (5.4%), whereas both TTO (7.5%) and MPFLRTTO (7.1%) had greater complication rates (P < .001). MPFLR had the greatest rate of revision stabilization surgery at 3.7% compared with TTO at 2.7% and MPFLRTTO, which carried the lowest risk for revision at 2.4% (P < .001). Conclusions: Isolated MPFLR is the most common modality used for patellar instability, with increasing prevalence and the lowest 2-year complication rate. Isolated TTO was unchanged in its use and had the greatest overall complication rate. Combined MPFLRTTO increased the overall complication rate but had a lower 2-year rate of recurrent instability requiring revision than MPFLR alone. Level of Evidence: Level III, retrospective cohort study.http://www.sciencedirect.com/science/article/pii/S2666061X24001317 |
| spellingShingle | Alexander R. Markes, M.D. Ramesh B. Ghanta, M.D. Alan L. Zhang, M.D. C.Benjamin Ma, M.D. Brian T. Feeley, M.D. Drew A. Lansdown, M.D. Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone Arthroscopy, Sports Medicine, and Rehabilitation |
| title | Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone |
| title_full | Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone |
| title_fullStr | Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone |
| title_full_unstemmed | Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone |
| title_short | Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone |
| title_sort | combined medial patellofemoral ligament reconstruction and tibial tubercle osteotomy has a lower risk of recurrent instability requiring revision stabilization at 2 years than either procedure alone |
| url | http://www.sciencedirect.com/science/article/pii/S2666061X24001317 |
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