Patellofemoral Update

Patellofemoral Update

July 08, 2019
3 min read

Age, gender did not impact patient-reported outcomes after MPFL reconstruction

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According to recently published results, age at first dislocation and patient gender did not influence patient-reported quality of life outcomes after medial patellofemoral ligament reconstruction when adjusted for risky pathoanatomy.

“By stratifying for pathoanatomic risk factors, this study has clarified that females do not have poorer outcomes following [medial patellofemoral ligament] MPFL reconstruction based on their sex,” Laurie Hiemstra, MD, told “Previous research has correlated female sex with poorer outcomes after patellar stabilization surgery, however females demonstrate a greater number of pathoanatomic risk factors, which adversely influence outcomes. Likewise, individuals who dislocate at a young age are likely to have a greater number of pathoanatomic risk factors.”

She added, “In this large cohort in which concomitant surgeries corrected for significant pathoanatomy, age at the time of surgical stabilization was the only factor that correlated with patient-reported outcome, with older patients demonstrating inferior scores compared with younger patients.”

Researchers identified 328 patients who underwent primary patellofemoral stabilization with MPFL reconstruction. At the preoperative and postoperative visits, patients completed the Banff Patellofemoral Instability Instrument (BPII). Of the 328 patients, 298 patients had complete data and minimum 12-month BPII scores. At 12 and 24 months, patients were assessed clinically. Multiple linear regression models were fit to predict BPII at 12 and 24 months to evaluate the impact of age at surgery and patient gender on BPII. Age at the time of surgery and sex were used as predictors for an unadjusted regression model, and a second regression model was used and adjusted for age at first dislocation, grade of trochlear dysplasia, knee hyperextension and the weak, atraumatic, risky anatomy, pain, and subluxation/strong, traumatic, anatomy normal, instability and dislocation (WARPS/STAID) score.

Results showed 11 redislocations and all were seen in women. Baseline characteristics, when stratified by sex ,were not significantly different apart from older age at first dislocation and higher WARPS/STAID scores for men. For each postoperative follow-up, age at the time of surgery was statistically significant, with lower BPII scores seen with a 10-year increase in age at the time of surgery. The WARPS/STAID score significantly correlated with the preoperative BPII score in the adjusted model. Age at the time surgery and preoperative WARPS/STAID score were significant for 24-month BPII postoperative scores. Lower BPII scores were seen for each 10-year increase in age at time of surgery, with lower scores for WARPS/STAID. – by Monica Jaramillo

Disclosure s : Hiemstra reports consulting fees from ConMed Linvatec and Smith & Nephew; research funds from ConMed Canada and Tribe Medical; project-specific funding from Sanofi-Genzyme, Pendopharm, Covenant Health and EFX; speaking and education fees from ConMed Linvatec, Smith & Nephew, Sanofi-Genzyme and Concession Medical; and reimbursement for attending a symposium from ConMed Linvatec, Smith & Nephew, Sanofi-Genzyme and Pendopharm. Please see the full study for a list of all other authors’ relevant financial disclosures.