Patellofemoral Update

Patellofemoral Update

November 13, 2019
3 min read

Several factors led to lower quality of life outcomes after MPFL reconstruction

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Laurie A. Hiemstra

Published results showed bilateral symptoms, femoral tunnel position and age at first dislocation were statistically significant predictors of lower postoperative quality of life scores among patients who underwent isolated medial patellofemoral ligament reconstruction. However, researchers found no anatomic risk factors predicted quality of life outcomes.

To identify predictors of disease-specific quality of life (QoL) outcomes in 224 patients who underwent isolated medial patellofemoral ligament (MPFL) reconstruction for treatment of symptomatic lateral patellofemoral instability, Laurie A. Hiemstra, MD, PhD, FRCSC, and colleagues collected demographic data and measured pathoanatomic risk factors, including the presence of high-grade trochlear dysplasia, tibial tubercle-trochlear groove (TT-TG) distance, patella alta ratio, Beighton score and patellar tilt. Researchers also measured femoral tunnel position accuracy.

Results showed the mean age of first patellar dislocation was 15.7 years. Overall, 41.4% of patients had bilateral instability, according to results. Researchers found 41% and 46% of patients had high- and low-grade dysplasia, respectively. A TT-TG distance of 18 mm or more was found in 17% of patients, and 22% of patients had a Caton-Deschamps ratio of 1.2 or greater, according to results. Researchers noted 38% of patients had a positive Beighton score, 46% of patients had knee hyperextension, 25% of patients had femoral internal rotation and 85% of patients had a patellar chondral lesion.

A 2 years postoperatively, results showed patients had a mean Banff Patellofemoral Instability Instrument score of 67.1. In an assessment of individual variables, researchers found statistically significant predictors of lower QoL scores included bilateral symptoms, older age at first dislocation and femoral tunnel position 0.10 mm from Schöttle’s point.

“This well powered regression analysis found that the presence of bilateral symptoms, femoral tunnel position and age at first dislocation were predictors of lower quality of life scores following isolated MPFL reconstruction. The inability of this study to identify pathoanatomic features, such as patella alta and trochlear dysplasia, is disappointing,” Hiemstra told “It may be that the lack of precise and reliable classification systems for these risky pathoanatomic features reduced the opportunity to statistically identify if these influence quality of life outcomes. In addition, the range of combinations of demographic and pathoanatomic characteristics that patellofemoral instability patients present with may require a substantially larger population in order to flesh out these relationships given how many factors influence disease-specific quality of life scores.” – by Casey Tingle


Disclosures: Hiemstra reports she has completed educational consultancy work for ConMed Corporation, Sanofi-Aventis Canada, Pendopharm Canada and Concession Medical Canada. Please see the study for a list of all other authors’ relevant financial disclosures.