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Clinical Outcomes Following Anatomic Medial Patellofemoral Ligament Reconstruction With Concomitant Procedures in
Brock J Manley1, Thomas E Moran1, Jonathan Ham1
1Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Background:
Patellar instability is common in skeletally immature patients; however, the presence of open physes presents unique challenges to surgical management.
Purpose:
To (1) assess the safety and efficacy of anatomic medial patellofemoral ligament reconstruction (MPFL-R) in a skeletally immature patient population at short-, mid-, and long-term follow-up and (2) determine the influence of patient factors and surgical and radiographic characteristics on the risk of recurrent instability and clinical outcomes after surgery.
Study Design:
Case series; Level of evidence, 4.
Methods:
A retrospective analysis was conducted of the records of skeletally immature patients who underwent primary, anatomic MPFL-R with concomitant procedures at a single academic institution between 2010 and 2019. Patients with <2 years of follow-up were excluded. Demographic data, preoperative radiographic parameters, and surgical details were collected through chart review. Recurrent instability, growth disturbance, and return-to-sport rates were documented via telephone follow-up. The final follow-up included assessment of Kujala, Lysholm, and International Knee Documentation Committee (IKDC) scores. Subgroup analysis focused on patients undergoing isolated MPFL-R.
Results:
A total of 54 knees in 51 skeletally immature patients with a mean age of 15.6 years (range, 10-18 years) were available for analysis. At a mean follow-up of 8.15 years (range, 55-152 months), 4 of 54 (7.4%) knees experienced subsequent patellar subluxation events. There were no confirmed patellar dislocations, and no patients underwent reoperation for patellar stabilization or growth disturbance. At the final follow-up, the mean Kujala, Lysholm, and IKDC scores were 85.7 (range, 11-100), 83.6 (range, 14-100), and 76.1 (range, 10-95.4), respectively. Patients with a younger age at the time of surgery (hazard ratio, -0.83; 95% CI, -1.53 to -0.14; P = .018) and an increased patellar tendon-to-lateral trochlear ridge (PT-LTR) distance (13.46 vs 8.59 mm; P = .043) demonstrated an increased risk of recurrent patellar instability. Three of 23 (13.0%) knees undergoing isolated MPFL-R, experienced subsequent patellar subluxation events. In subgroup analysis, high-grade trochlear dysplasia (P = .002) and PT-LTR distance >5.55 mm (P = .004) correlated with an increased risk of recurrent instability events.
Conclusion:
Anatomic MPFL-R paired with concomitant procedures as indicated is a safe, efficacious, and durable treatment option for lateral patellar instability in adolescent patients with an open or partially open distal femoral physis.
