Tags

Type your tag names separated by a space and hit enter

Primary Medial Patellofemoral Ligament Repair Versus Reconstruction: Rates and Risk Factors for Instability Recurrence in a Young, Active Patient Population.
Arthroscopy 2019; 35(10):2909-2915A

Abstract

PURPOSE

To comparatively evaluate the clinical outcomes and rates of recurrent instability in young patients with primary medial patellofemoral ligament (MPFL) repair or reconstruction, as well as to assess for radiologic risk factors for worse outcomes.

METHODS

A retrospective review identified all patients with lateral patellar instability who underwent either MPFL repair and/or imbrication or MPFL reconstruction without any additional osseous procedures between 2008 and 2015 at a single center. Demographic variables and preoperative magnetic resonance imaging were analyzed, and Kujala scores were obtained at a minimum 2-year follow-up. Risk factors for worse outcomes were assessed, including the Caton-Deschamps Index (CDI) Insall-Salvati Index, tibial tubercle-trochlear groove distance, and tibial tubercle-posterior cruciate ligament distance.

RESULTS

We identified 51 knees with isolated MPFL surgery (reconstruction in 32 and imbrication and/or repair in 19) at a mean of 59.7 months' follow-up (range, 24-121 months). The overall rate of recurrent dislocations was significantly greater in the repair group (36.9%) versus the reconstruction group (6.3%, P = .01), despite the average CDI being significantly higher in the reconstruction group (1.34 vs 1.23 in repair group, P = .04). No significant difference in the rate of return to baseline activity was found between the groups (77.8% in reconstruction group vs 70% in repair group, P = .62). The average Kujala score showed no significant difference between the repair and reconstruction groups (84.15 ± 14.2 vs 84.83 ± 14.38, P = .72). No imaging measurements were found to be predictive of a worse postoperative Kujala score; however, the average CDI among the MPFL repair failures (1.30 ± 0.05) was significantly higher than among the MPFL repair nonfailures (1.18 ± 0.12, P = .03).

CONCLUSIONS

MPFL reconstruction may provide improved midterm clinical outcomes and a decreased recurrence rate compared with MPFL repair. Increased patellar height as measured by the CDI may be a risk factor for recurrent patellar instability in patients who undergo isolated MPFL repair.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Authors+Show Affiliations

Tufts Medical Center, Boston, Massachusetts.Orthopaedic Services, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A.Westchester Medical Center, Valhalla, New York.Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: forsythe.research@rushortho.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31604512

Citation

Puzzitiello, Richard N., et al. "Primary Medial Patellofemoral Ligament Repair Versus Reconstruction: Rates and Risk Factors for Instability Recurrence in a Young, Active Patient Population." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 35, no. 10, 2019, pp. 2909-2915.
Puzzitiello RN, Waterman B, Agarwalla A, et al. Primary Medial Patellofemoral Ligament Repair Versus Reconstruction: Rates and Risk Factors for Instability Recurrence in a Young, Active Patient Population. Arthroscopy. 2019;35(10):2909-2915.
Puzzitiello, R. N., Waterman, B., Agarwalla, A., Zuke, W., Cole, B. J., Verma, N. N., ... Forsythe, B. (2019). Primary Medial Patellofemoral Ligament Repair Versus Reconstruction: Rates and Risk Factors for Instability Recurrence in a Young, Active Patient Population. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 35(10), pp. 2909-2915. doi:10.1016/j.arthro.2019.05.007.
Puzzitiello RN, et al. Primary Medial Patellofemoral Ligament Repair Versus Reconstruction: Rates and Risk Factors for Instability Recurrence in a Young, Active Patient Population. Arthroscopy. 2019;35(10):2909-2915. PubMed PMID: 31604512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary Medial Patellofemoral Ligament Repair Versus Reconstruction: Rates and Risk Factors for Instability Recurrence in a Young, Active Patient Population. AU - Puzzitiello,Richard N, AU - Waterman,Brian, AU - Agarwalla,Avinesh, AU - Zuke,William, AU - Cole,Brian J, AU - Verma,Nikhil N, AU - Yanke,Adam B, AU - Forsythe,Brian, PY - 2018/08/31/received PY - 2019/04/09/revised PY - 2019/05/01/accepted PY - 2019/10/13/entrez PY - 2019/10/13/pubmed PY - 2019/10/13/medline SP - 2909 EP - 2915 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 35 IS - 10 N2 - PURPOSE: To comparatively evaluate the clinical outcomes and rates of recurrent instability in young patients with primary medial patellofemoral ligament (MPFL) repair or reconstruction, as well as to assess for radiologic risk factors for worse outcomes. METHODS: A retrospective review identified all patients with lateral patellar instability who underwent either MPFL repair and/or imbrication or MPFL reconstruction without any additional osseous procedures between 2008 and 2015 at a single center. Demographic variables and preoperative magnetic resonance imaging were analyzed, and Kujala scores were obtained at a minimum 2-year follow-up. Risk factors for worse outcomes were assessed, including the Caton-Deschamps Index (CDI) Insall-Salvati Index, tibial tubercle-trochlear groove distance, and tibial tubercle-posterior cruciate ligament distance. RESULTS: We identified 51 knees with isolated MPFL surgery (reconstruction in 32 and imbrication and/or repair in 19) at a mean of 59.7 months' follow-up (range, 24-121 months). The overall rate of recurrent dislocations was significantly greater in the repair group (36.9%) versus the reconstruction group (6.3%, P = .01), despite the average CDI being significantly higher in the reconstruction group (1.34 vs 1.23 in repair group, P = .04). No significant difference in the rate of return to baseline activity was found between the groups (77.8% in reconstruction group vs 70% in repair group, P = .62). The average Kujala score showed no significant difference between the repair and reconstruction groups (84.15 ± 14.2 vs 84.83 ± 14.38, P = .72). No imaging measurements were found to be predictive of a worse postoperative Kujala score; however, the average CDI among the MPFL repair failures (1.30 ± 0.05) was significantly higher than among the MPFL repair nonfailures (1.18 ± 0.12, P = .03). CONCLUSIONS: MPFL reconstruction may provide improved midterm clinical outcomes and a decreased recurrence rate compared with MPFL repair. Increased patellar height as measured by the CDI may be a risk factor for recurrent patellar instability in patients who undergo isolated MPFL repair. LEVEL OF EVIDENCE: Level III, retrospective comparative study. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/31604512/Primary_Medial_Patellofemoral_Ligament_Repair_Versus_Reconstruction:_Rates_and_Risk_Factors_for_Instability_Recurrence_in_a_Young,_Active_Patient_Population L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(19)30403-7 DB - PRIME DP - Unbound Medicine ER -