Outcomes of surgical stabilization in patients with combined ACL deficiency and patellofemoral instability - A case series.
BACKGROUND
The purpose of this study was to assess the disease-specific quality of life, and the objective clinical and functional outcomes of patients with symptomatic ACL deficiency and patellofemoral instability following surgical stabilization of both ligaments.


METHODS
Between February 2010 and August 2013, 22 subjects underwent a combined ACL reconstruction and patellofemoral stabilization. The anterior cruciate ligament quality of life questionnaire (ACL-QOL) was completed pre-operatively and two-years post-operatively. Clinical and functional assessments were performed two-years post-operatively. A paired t-test assessed the difference between the pre- and post-operative ACL-QOL scores. Effect size was calculated manually using the Eta squared formula. A Pearson r correlation coefficient assessed for a relationship between the post-operative ACL-QOL scores and functional tests.


RESULTS
Twenty patients completed the 24-month ACL-QOL, 17/20 completed clinical assessment, and 14/20 completed functional testing. The mean pre-operative ACL-QOL score was 21.20 (SD=7.25, range 5.8 to 31.7) and two-years post-operative it was 65.24 (SD=21.38, range 34.5 to 99.1). The paired t-test demonstrated a statistically significant improvement in ACL-QOL scores; t (19)=9.119, p<.001 (two-tailed). The Eta squared statistic (0.81) indicated a very large effect size. Statistically significant correlations (p<.05) were evident between post-operative ACL-QOL scores and all the operative limb single-leg hop tests.


CONCLUSIONS
Combined ACL reconstruction and patellofemoral stabilization surgery leads to good results. This patient cohort with chronic ACL-MPFL injuries demonstrated a statistically significant change in disease-specific quality of life following surgery. In addition, the patient-reported outcomes and objective functional testing results correlated.


METHODS
Case series - IV.
Banff Sport Medicine, Banff, Canada; Department of Surgery, University of Calgary, Calgary, Canada. Electronic address: hiemstra@banffsportmed.ca.
Laurie A
LA
Hiemstra
Banff Sport Medicine, Banff, Canada; Department of Physical Therapy, University of Alberta, Edmonton, Canada.
Sarah
S
Kerslake
Banff Sport Medicine, Banff, Canada; Department of Surgery, University of Calgary, Calgary, Canada.
Mark
M
Heard
Banff Sport Medicine, Banff, Canada; Department of Surgery, University of Calgary, Calgary, Canada.
Gregory
G
Buchko
Department of Health and Physical Education, Mount Royal University, Calgary, Canada.
Mark
M
Lafave
D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint; D008297:Male; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
ACL reconstruction; Anterior cruciate ligament deficiency; Functional testing; MPFL reconstruction; Patellar dislocation; Patellofemoral instability; Patellofemoral stabilization; Quality of life