Abstract
Background:
Recurrent lateral patellar instability is common in adolescent patients, often requiring surgical intervention. Medial quadriceps tendon femoral ligament reconstruction (MQTFLR) has emerged as an alternative to medial patellofemoral ligament reconstruction (MPFLR), avoiding patellar fixation and its associated complications. However, data on short-term clinical outcomes and return to activity (RTA) following MQTFLR in adolescent patients remains limited.
Objectives:
In adolescent patients with recurrent lateral patellar instability, MQTFLR will result in favorable short-term clinical outcomes and RTA, with low complication rates, and improved knee function and patellar stability.
Methods:
Adolescent patients (≤19 years) who underwent primary allograft MQTFLR at a single institution between 2017 and 2023 were retrospectively reviewed. Inclusion criteria required both pre- and postoperative patient-reported outcomes (PROs) with a minimum of 1-year follow-up. The primary outcome was the change from baseline in PROs, including Pedi-IKDC, Tegner, and Lysholm scores. RTA rates and complications were also assessed. A Wilcoxon signed rank test was used to compare pre- and postoperative PROs, with statistical significance set at P ≤ .05.
Results:
A total of 44 patients (mean age 15±1.8 years, 59% female) underwent MQTFLR. Multiple preoperative dislocations were reported in 64%, and 25% underwent simultaneous tibial tubercle osteotomy. Median follow-up was 23.8 months [IQR 12.7,24.3]. RTA data was available for 33 patients, with 82% attempting to return to their primary activity and 89% of those returning at the same or higher level. Statistically significant improvements were observed in Pedi-IKDC (57.61 [49.73, 67.66] to 95.65 [81.25, 98.10]; P <0.001), Tegner (3.00 [2.00, 4.00] to 8.00 [5.75, 9.00]; P <0.001), and Lysholm (71.00 [54.75, 83.25] to 95.00 [85.00, 100.00]; P <0.001) scores. Two patients (4.5%) experienced recurrent patellar instability at an average of 33.5 months post-surgery.
Conclusion:
MQTFLR is a safe and effective surgical option for adolescent patients with recurrent lateral patellar instability, resulting in significant improvements in PROs and a high rate of RTA at the same or higher level. Further research is needed to assess long-term outcomes and identify factors that may influence postoperative recovery.
