Risk factors identified for recurrent instability in treatment of osteochondral defects without MPFL reconstruction
Adolescent patients had a 61% recurrent instability rate if the medial patellofemoral ligament was not reconstructed during index surgery for an osteochondral loose body, according to recently published results.
“Since looking at our institution’s data, I now favor reconstructing the [medial patellofemoral ligament] MPFL in adolescent first-time patella dislocators who are going to the operating room for an osteochondral fracture or a chondral loose body,” Andrew T. Pennock, MD, told Healio.com/Orthopedics.
Pennock and colleagues performed a retrospective analysis of data for 41 adolescent patients who were treated surgically for acute patellar dislocation with associated chondral or osteochondral loose bodies. The minimum follow-up was 2 years. Investigators recorded demographic, injury-related, radiographic and surgical risk factors. Recurrent subluxation and or dislocation was the primary outcome. Other outcomes included the Kujala score, single assessment numerical evaluation (SANE) score, patient satisfaction and the need for additional procedures.
Results showed at a mean follow-up of 4.1 years, 61% of patients experienced recurrent instability. Investigators noted 39% of patients needed subsequent MPFL reconstruction. A risk factor for recurrent instability was a tibial tubercle-trochlear groove (TT-TG) distance of greater than 15 mm. Recurrent instability rates in patients with a TT-TG distance greater than 15 mm and greater than 20 mm were 75% and 86%, respectively. The rate of recurrent instability was not decreased with MPFL repair. There was an association between recurrent instability and worse mean Kujala, SANE and patient satisfaction scores. – by Monica Jaramillo
Disclosures: Pennock reports that he receives payments from Smith & Nephew, Arthrex and SportsTek Medical. Please see the full study for a list of all other authors’ relevant financial disclosures.