Medial patellofemoral ligament reconstruction is the gold standard for soft tissue stabilization following recurrent patella dislocation. Controversy remains regarding the threshold for adding concomitant procedures to MPFL reconstruction. Sappey-Marinier and colleagues performed a retrospective review of prospectively collected data on 239 isolated MPFL reconstructions (average follow-up 5.8 years). Kujala improved from 56.1 to 88.8 (P< .001), with 94% return to same level of sport. There was a 4.7% revision rate. Risk factors for failure included patella alta (Caton-Deschamps index [CDI] >1.3, odds ratio 4.9, P=.02) and a positive preoperative J-sign (odds ratio 3.9, P= .04). There was a correlation between preoperative J-sign and severe trochlear dysplasia (OR 16.9, P< .001)
Strengths include large numbers with medium follow-up and standardized surgical regimen performed by experienced surgeons. Weaknesses include inherent bias associated with nonrandomized or controlled design, retrospective review, lack of complete clinical and radiographic results and 11.7% loss to follow-up.
Overall, soft tissue stabilization appears safe and effective for the vast majority of patients with recurrent patella instability. Pre-surgical risk stratification may help to identify those at higher risk of failure (ie, CDI >1.3, preoperative J-sign with severe trochlear dysplasia) who warrant consideration for concomitant procedures. Prospective studies are ongoing to provide more definitive guidance.
Erickson BJ, et al. Am J Sports Med. 2019;doi:10.1177/0363546519835800.
Liu JN, et al. Am J Sports Med. 2018;doi:10.1177/0363546517745625.
Kita K, et al. Am J Sports Med. 2015;doi:10.1177/0363546515606102.
Sappey-Marinier E, et al. Am J Sports Med. 2019;doi:10.1177/0363546519838405.
Seth L. Sherman, MD
Associate professor of orthopedic surgery
Co-division director of sports medicine
University of Missouri
Disclosure: Sherman reports no relevant financial disclosures.
Disclosures: Sherman reports no relevant financial disclosures.