• Yimeng Yang and Qiang Zhang.
• Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
• Knee Surg Sports Traumatol Arthrosc. 2019 Aug 1; 27 (8): 2599-2607.

PurposeTo evaluate the clinical outcome of the combined reconstruction of the medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) for patellar instability with patella alta.MethodsA total of 108 patients underwent a combined reconstruction of the MPFL and MPTL, and 58 patients were included in this study. The clinical results were evaluated and compared using the International Knee Documentation Committee (IKDC) scores, Kujala scores, and visual analogue scale (VAS) scores. The tibial tuberosity-trochlear groove (TT-TG) distance, three indices of patellar height (Insall-Salvati ratio, modified Insall-Salvati ratio, and Caton-Deschamps index), and patellar shift and tilt were defined preoperatively and at the 12- and 24-month follow-up visits.ResultsAt the 12- and 24-month follow-up visits, 86.2% (50/58) and 87.9% (51/58) of the subjective outcomes were excellent, 5/58 (8.6%) and 4/58 (6.9%) were good, 1/58 (1.7%) and 2/58 (3.4%) were fair, and 2/58 (3.4%) and 1/58 (1.7%) were poor. There were significant improvements in the IKDC scores, from 51.9 ± 13.8 preoperatively to 80 ± 19.2 (P < 0.05) at 12 months and 85 ± 13.9 (P < 0.05) at 24 months; Kujala scores, from 55.1 ± 15.2 preoperatively to 82.6 ± 14.9 (P < 0.05) at 12 months and 89.5 ± 10.2 (P < 0.05) at 24 months; and VAS scores, from 58 ± 11 preoperatively to 12 ± 5 (P < 0.05) at 12 months and 11 ± 4 (P < 0.05) at 24 months. The patellar tilt, patellar shift, Insall-Salvati ratio, modified Insall-Salvati ratio, Caton-Deschamps index, and TT-TG distance all decreased significantly compared with the preoperative values, and there were no significant differences between the values at the 12- and 24-month follow-ups.ConclusionThe results of this study show that a combined reconstruction of the MPFL and MPTL is an effective treatment for patellar instability with patella alta. This article emphasizes the combined effect of MPFL and MPTL instead of MPFL alone and provides an effective option for the treatment of recurrent patellar dislocation with patella alta.Level Of EvidenceCase series, Level IV.

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