Clinical Outcomes of Patients with Osteochondral Defects Secondary to Patella Dislocation: A Comparative Study

Osteochondral injuries secondary to patella dislocation are common and represent a significant complication of patellar instability. Despite the frequency of this injury, there are no published studies comparing outcomes between patients undergoing isolated medial patellofemoral ligament (MPFL) reconstruction for patellar instability versus patients undergoing MPFL reconstruction combined with procedures to address associated osteochondral defects. To evaluate differences in patient-reported outcome measures (PROMs), complications and revision rates between patients requiring MPFL reconstruction with osteochondral defects versus patients requiring MPFL reconstruction without osteochondral defects. A retrospective review of all patients undergoing MPFL reconstruction for patellar instability between April 2019 and March 2023 was performed. Patients were grouped into those requiring MPFL reconstruction combined with a procedure to address a concomitant osteochondral defect and those who underwent isolated MPFL reconstruction. Preoperative magnetic resonance imaging was used to assess anatomical risk factors for patella instability. At follow-up Lysholm, IKDC, KOOS-PF, satisfaction, and return to sport were evaluated. The study included 44 knees (18 and 26 for the osteochondral defect and isolated MPFL groups, respectively), with a mean age of 21.8 years and a mean follow-up of 23.1 months. The osteochondral defect group had a lower Insall-Salvati ratio (p = 0.03). At follow-up, the osteochondral defect group had lower Lysholm and Kujala scores (p = 0.01 and 0.002). Overall, 66.7% and 88.5% of participants in the osteochondral defect group and isolated MPFL groups, respectively, responded as being very satisfied with the results of surgery (p = 0.13). The return to play rate was 10.0% and 61.9% in the osteochondral defect and isolated MPFL groups, respectively (p = 0.009). Patients with osteochondral defects occurring secondary to patella dislocation had lower Insall-Salvati ratios and lower postoperative PROMs at follow-up. These findings highlight the significant impact of osteochondral injuries on patient outcomes in patients undergoing patellar stabilization surgery.

LEVEL OF EVIDENCE:  Cohort study; Level of evidence, 3.