Gurusamy P, et al. ePoster 191. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 8-9, 2020 (virtual meeting).
Study examines MPFL reconstruction in adolescents with instability vs no reconstruction
Medial patellofemoral ligament reconstruction in adolescent patients with patella instability results in less instability and subsequent surgery compared with no reconstruction surgery, according to presented findings.
“Patella instability, as we all know, is common adolescent population and recurrent instability rates are as high as 50% to 90%, depending on the number of risk factors that the patient has,” Andrew T. Pennock, MD, of Rady Children’s Hospital in San Diego, said in a presentation for the American Orthopaedic Society for Sports Medicine Annual Meeting. The meeting was held virtually. Pennock said, “It tends to require surgical intervention, either removal or open reduction internal fixation. The question remains: What should be done with the MPFL at the time of this surgery?”
In a retrospective study, investigators analyzed data of 51 adolescent patients (mean age: 14 years) who sustained a patellar instability that resulted in an intra-articular loose body for “MPFL neglect” (n= 21) vs. MPFL reconstruction (n=23) outcomes. Researchers performed chart and radiographic reviews and evaluated other variables including Insall-Salvati ratios.
Study results showed the reconstruction cohort developed significantly less instability compared to the MPFL-neglected cohort (16.7% vs. 58.7%, respectively), as well as fewer patients requiring subsequent surgery . Further, investigators found statistically significant differences in Insall-Salvati ratios (mean 1.3 vs. mean 1.4, respectively), while no other statistically significant differences were found among other evaluated variables.
“MPFL reconstruction in the setting of an adolescent athlete with patellar dislocation of the intra-articular was spotty. This results in a significantly lower rate of recurrent instability compared to those who did not undergo ligament reconstruction,” Pennock concluded. “It really raises the question what is worse for the knee: having further episodes of recurrent instability or potentially over-constraining with MPFL reconstruction, and that is why the future follow-up will be important.”