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Salvage of failed patellofemoral arthroplasty due to instability: Combined medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, and vastus medialis obliquus advancement-Case report and algorithm-based
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DOI：10.1016/j.jisako.2025.101063.png)
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Abstract
En 中文
Introduction/Objectives: Patellofemoral arthroplasty (PFA) is a joint-sparing alternative to total knee arthroplasty (TKA) for isolated patellofemoral osteoarthritis, offering symptom relief while preserving tibiofemoral compartments and bone stock compared with TKA, particularly in younger and active patients. However, persistent anterior knee pain and patellar instability remain the leading causes of early failure, even when prosthetic components are stable and tibiofemoral degeneration is absent. This study aimed to describe a combined, nonprosthetic surgical strategy for symptomatic PFA failure due to patellar instability and to propose an algorithm-based framework for clinical decision-making. Methods: A 54-year-old woman presented with chronic anterior knee pain and recurrent instability four years after isolated PFA. Imaging confirmed stable and well-aligned prosthetic components with preserved tibiofemoral compartments but consistent lateral patellar subluxation. The patient was treated using a joint-preserving approach combining medial patellofemoral ligament (MPFL) reconstruction with hamstring autograft, anteromedial tibial tubercle osteotomy (TTO), and vastus medialis obliquus (VMO) advancement. Clinical outcomes were assessed with the Kujala and International Knee Documentation Committee (IKDC) scores at six weeks and three months. Results: At three months, the Kujala score improved from 54 to 78, and the IKDC subjective score increased from 38 to 69. The patient reported significant pain reduction, restoration of patellar stability, and functional recovery. No recurrent instability, surgical complications, or implant-related problems were observed. Radiographs confirmed correct alignment and congruent prosthetic components. Conclusion: A combined approach addressing soft-tissue, bony, and dynamic stabilizers may provide an effective, joint-preserving alternative to TKA in selected patients with symptomatic PFA failure caused by instability. The algorithm presented may assist in surgical decision-making and optimize patient outcomes. Level of evidence: V.
Keywords:
Patellofemoral arthroplasty
Prosthesis failure
MPFL reconstruction
Tibial tubercle osteotomy
VMO advancement
Revision knee surgery
Joint preservation
Journal
J
IF:
3.3
Papers:
14
Citations:
0
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