Nguyen J, et al. ePaper 192. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 8-9, 2020 (virtual meeting).
Similar results seen in skeletally immature, mature patients after ligament reconstruction
Similar outcomes and recurrence rates were found in skeletally immature and mature patients who underwent medial patellofemoral ligament reconstruction for recurrent lateral patellar instability, according to presented results.
“Adult-type reconstruction techniques have been avoided in young patients due to the proximity of the femoral insertion of the [medial patellofemoral ligament] MPFL to the distal femoral physis,” said Joseph Nguyen, MPH, a musculoskeletal health specialist at Hospital for Special Surgery, who presented findings on MPFL reconstruction at the American Orthopaedic Society for Sports Medicine Annual Meeting. The meeting was held virtually.
“It is currently unclear how outcomes of MPFL reconstruction in skeletally immature patients compare to those who are skeletally mature patients,” Nguyen said in the presentation. “Many have suggested waiting until the growth plate closes before operating; however, between the risk of cartilage injury with each subsequent dislocation and the long-term effects on the young knee, the risk of waiting maybe even the higher,” he said.
From March 2014 to July 2018, Nguyen and colleagues analyzed 107 patients (25 skeletally immature patients and 82 skeletally mature patients) who underwent isolated MPFL reconstruction. Researchers compared return-to-sport rates and re-dislocation episodes. They also compared outcomes between standard, adult graft placement and graft placement distal to the physis, which avoids the growth plate, in a strictly pediatric cohort.
“Over 90% of patients were able to return to sport in both groups, with a high percentage of patients in both groups returning at the same or an even higher level of activity,” Nguyen said. “In the sub-analysis of skeletally immature patients, no differences were found in any outcomes between patients with standard graft placement vs. those with distal graft placement,” he said.
Additionally, no patients reported postoperative dislocations.
“Successful outcomes can be achieved in skeletally immature patients following MPFL reconstruction, or over these outcomes are aligned with outcomes in the skeletally mature patients,” Nguyen concluded. “Future studies with larger populations are needed to further investigate if any morphological differences impact patient outcomes, and additional studies are needed to study the impact of graft placement on the younger population,” he added.