Akademik Veri Yönetim Sistemi
Journal of Orthopaedic Science, 2025 (SCI-Expanded, Scopus)
Purpose: This study aimed to evaluate the influence of psychological factors, demographics, and radiological parameters on functional outcomes following combined medial patellofemoral ligament reconstruction (MPFLr) and tibial tubercle transfer (TTT) for recurrent lateral patellar instability. Methods: A cross-sectional study was conducted on 31 patients who underwent unilateral MPFLr with TTT between 2019 and 2023. Preoperative and postoperative evaluations included the Caton–Deschamps (CD) index, tibial tubercle–trochlear groove (TT-TG) distance, patellar tilt, and trochlear morphology (sulcus angle, trochlear groove angle, sagittal spur, and lateral trochlear inclination). Patient-reported outcomes were assessed with the Kujala score, KOOS subscales, and the SF-12 physical (PCS-12) and mental (MCS-12) scores, which represent health-related quality of life (QoL). Psychological assessments included the Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (Pcs), and Brief Resilience Scale (BRS). Potential predictors of functional outcomes were analyzed using a post-LASSO ordinary least squares (OLS). Results: Significant postoperative reductions were observed in TT-TG distance (22.45 ± 2.69 mm to 10.58 ± 3.51 mm, p < 0.001), CD index (1.53 ± 0.40 to 1.07 ± 0.26, p < 0.001), and patellar tilt (36.52 ± 11.26° to 18.03 ± 8.38°, p < 0.001). Females demonstrated higher TT-TG index and trochlear groove angle, despite comparable postoperative corrections. Females also showed poorer functional outcomes on the Kujala scale (p = 0.010), KOOS symptoms (p = 0.008), and KOOS sport/recreation (p = 0.048). Psychological analyses revealed higher TSK scores in females (p = 0.039). Post-LASSO OLS showed kinesiophobia as a significant negative predictor of Kujala, KOOS sport/recreation, KOOS knee-related QoL, and total KOOS scores, whereas resilience positively predicted PCS-12. Sulcus angle independently predicted higher KOOS pain, symptoms, and ADL. Conclusions: Combined MPFLr and TTT corrected malalignment, significantly decreasing TT-TG distance, tilt, and height. Female patients had poorer outcomes, but kinesiophobia emerged as the strongest negative factor, resilience supported health-related QoL, and sulcus angle independently predicted unfavorable KOOS subscales. Beyond surgical correction, treatment should integrate psychological factors—often neglected—into multidisciplinary rehabilitation, particularly for female patients. Level of evidence: Level IV.