Small, Short, Oblique Patellar Tunnels with Looped Graft Versus Suture Anchors for Patellar-Sided Graft Fixation During MPFL Reconstruction: A Study of Over 600 Knees.

Abstract

Background: There is a paucity of literature comparing clinical outcomes and complications between the use of 2 smaller (3.2 mm), short, oblique patellar tunnels with looped graft for patellar-sided graft fixation during medial patellofemoral ligament reconstruction (MPFLR) and the use of 2 suture anchors.

Purpose: To compare clinical outcomes and complications in large series between the use of dual patellar suture anchors and dual, small, short, oblique bone tunnels for patellar-sided graft fixation during MPFLR.

Study design: Retrospective cohort study; Level of evidence, 3.

Methods: A retrospective chart review identified all patients at a single academic institution who underwent primary MPFLR between March 2010 and December 2021, with a minimum 2-year follow-up. Operative notes, postoperative clinical follow-up notes, and radiographs were used to ascertain laterality, graft type, surgical technique, concomitant procedures, as well as the incidence of recurrent patellar instability, revision MPFLR, and patellar fracture. The follow-up was limited to a review of the postoperative clinic or emergency department visits, and patients were not contacted at the time of the study.

Results: A total of 635 knees were included for final analysis. Patellar-sided graft fixation was achieved with small, short, oblique bone tunnels with looped grafts in 342 knees (53.9%) and suture anchors in 293 knees (46.1%). The small, oblique tunnels and suture anchor techniques both yielded a low incidence of patellar fracture, with rates of 0.3% and 0%, respectively. No significant difference in rates of patellar fracture existed between cohorts (P≥ .999). There were similar rates of recurrent patellar instability events in patients in whom patellar-sided graft fixation was performed with dual, small, short, oblique bone tunnels (n = 9; 2.6%) compared with dual suture anchors (n = 15; 5.1%; P = .103). Similarly, no significant difference was found in revision MPFLR rates between groups (dual small, short, oblique patellar tunnels: n = 5; 1.5%; dual suture anchors: n = 8; 2.7%).

Conclusion: Two small (3.2 mm), short, oblique patellar tunnels with looped grafts and dual patellar suture anchors are similar in safety and efficacy for achieving patellar-sided graft fixation during MPFLR.