In the JournalsPerspective

Risk factors identified for recurrent instability in treatment of osteochondral defects without MPFL reconstruction

Andrew Pennock headshot
Andrew T. Pennock

Adolescent patients had a 61% recurrent instability rate if the medial patellofemoral ligament was not reconstructed during index surgery for an osteochondral loose body, according to recently published results.

“Since looking at our institution’s data, I now favor reconstructing the [medial patellofemoral ligament] MPFL in adolescent first-time patella dislocators who are going to the operating room for an osteochondral fracture or a chondral loose body,” Andrew T. Pennock, MD, told Healio.com/Orthopedics.

Pennock and colleagues performed a retrospective analysis of data for 41 adolescent patients who were treated surgically for acute patellar dislocation with associated chondral or osteochondral loose bodies. The minimum follow-up was 2 years. Investigators recorded demographic, injury-related, radiographic and surgical risk factors. Recurrent subluxation and or dislocation was the primary outcome. Other outcomes included the Kujala score, single assessment numerical evaluation (SANE) score, patient satisfaction and the need for additional procedures.

Results showed at a mean follow-up of 4.1 years, 61% of patients experienced recurrent instability. Investigators noted 39% of patients needed subsequent MPFL reconstruction. A risk factor for recurrent instability was a tibial tubercle-trochlear groove (TT-TG) distance of greater than 15 mm. Recurrent instability rates in patients with a TT-TG distance greater than 15 mm and greater than 20 mm were 75% and 86%, respectively. The rate of recurrent instability was not decreased with MPFL repair. There was an association between recurrent instability and worse mean Kujala, SANE and patient satisfaction scores. – by Monica Jaramillo

 

Disclosures: Pennock reports that he receives payments from Smith & Nephew, Arthrex and SportsTek Medical. Please see the full study for a list of all other authors’ relevant financial disclosures.

 

Andrew Pennock headshot
Andrew T. Pennock

Adolescent patients had a 61% recurrent instability rate if the medial patellofemoral ligament was not reconstructed during index surgery for an osteochondral loose body, according to recently published results.

“Since looking at our institution’s data, I now favor reconstructing the [medial patellofemoral ligament] MPFL in adolescent first-time patella dislocators who are going to the operating room for an osteochondral fracture or a chondral loose body,” Andrew T. Pennock, MD, told Healio.com/Orthopedics.

Pennock and colleagues performed a retrospective analysis of data for 41 adolescent patients who were treated surgically for acute patellar dislocation with associated chondral or osteochondral loose bodies. The minimum follow-up was 2 years. Investigators recorded demographic, injury-related, radiographic and surgical risk factors. Recurrent subluxation and or dislocation was the primary outcome. Other outcomes included the Kujala score, single assessment numerical evaluation (SANE) score, patient satisfaction and the need for additional procedures.

Results showed at a mean follow-up of 4.1 years, 61% of patients experienced recurrent instability. Investigators noted 39% of patients needed subsequent MPFL reconstruction. A risk factor for recurrent instability was a tibial tubercle-trochlear groove (TT-TG) distance of greater than 15 mm. Recurrent instability rates in patients with a TT-TG distance greater than 15 mm and greater than 20 mm were 75% and 86%, respectively. The rate of recurrent instability was not decreased with MPFL repair. There was an association between recurrent instability and worse mean Kujala, SANE and patient satisfaction scores. – by Monica Jaramillo

 

Disclosures: Pennock reports that he receives payments from Smith & Nephew, Arthrex and SportsTek Medical. Please see the full study for a list of all other authors’ relevant financial disclosures.

 

    Perspective
    Miho J. Tanaka

    Miho J. Tanaka

    In this study, Pennock and colleagues reported on 41 adolescent patients with first-time patellar dislocations who underwent surgery for the presence of a loose body at 64 +/- 104 days after initial injury; 16 patients (39%) underwent concurrent open or arthroscopic MPFL repair at the time of the index procedure. The authors reported 25 knees (61%) experienced recurrent instability at 4.1 years follow-up, with no difference in the group who underwent concurrent MPFL repair, and that 16 patients (39%) required subsequent MPFL reconstruction. A significant risk factor for redislocation was TT-TG distance greater than 15mm, which led to a 75% risk of subsequent instability. Because of this, the authors recommended that consideration be given to performing MPFL reconstruction or other stabilization procedures in the acute setting. 

    This study identifies a high rate of recurrence after acute intervention for first time patellar dislocations, particularly in those patients with greater TT-TG distances. This information should guide discussions with appropriate patients regarding expectations after surgery. Larger studies to determine the optimal timing of intervention, as well as further studies on the role, outcomes and complications of performing MPFL reconstruction in the acute setting are needed to better delineate the surgical treatment algorithm in first-time patellar dislocations.

    • Miho J. Tanaka, MD
    • Associate professor
      Department of orthopaedic surgery
      Director, Women’s Sports Medicine Program
      The Johns Hopkins Hospital
      Baltimore

    Disclosures: Tanaka reports no relevant financial disclosures.

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