Patients undergoing medial patellofemoral ligament reconstruction return to sport sooner and at a higher level than those undergoing concomitant tibial tubercle osteotomy

Abstract Purpose The purpose of the study was to compare time to return to sport between patients undergoing isolated medial patellofemoral ligament reconstruction (MPFL‐R) and patients undergoing MPFL‐R and concomitant TTO (MPFL‐TTO) for recurrent patellofemoral instability. Methods A retrospective chart review of prospectively collected data was conducted to identify consecutive patients who underwent primary isolated MPFL‐R or MPFL‐TTO. Exclusion criteria included concomitant cruciate ligament surgery, multi‐ligament surgery, failed previous surgery and <1 year follow‐up. Patient demographic information, surgical data, radiographic data, return to sport, and re‐dislocation rates were recorded. Pre‐operative and post‐operative functional outcome scores (Kujala, IKDC), activity level (Pedi‐FABS), and health‐related quality of life (KOOS‐PS, KOOS‐QOL) were compared. Results One hundred and seventy‐eight patients were included in the study. One hundred and nineteen patients (74% female) underwent isolated MPFL‐R, and 59 patients (85% female) underwent MPFL‐TTO. Patients who underwent MPFL‐R returned to sport at 9.5 ± 3.9 months, and patients who underwent MPFL‐TTO returned to sport at 12.9 ± 11.0 months ( p = 0.011). Patients who underwent isolated MPFL‐R had a significantly higher return to the same or higher level of sport compared to MPFL‐TTO (85% vs. 66%, p = 0.018). Both cohorts showed significant improvement in KOOS, IKDC, and Kujala scores at all follow‐ups ( p < 0.001). Conclusion Patients who underwent both isolated MPFL‐R and MPFL‐TTO had excellent return to sport rates, with isolated MPFL‐R patients reporting significantly higher rates of return to the same or higher level of sport. The MPFL‐R group returned to sport faster than those who had a concomitant TTO, with no difference in rates of recurrent instability. Patient‐reported outcomes for both groups were significantly improved at 5 years postoperatively. The results of this study contribute to the growing body of literature supporting excellent long‐term functional recovery with low rates of recurrent instability after isolated MPFL‐R or MPFL‐TTO. Level of Evidence Level III, cohort study.