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Stable outcomes found with isolated medial patellofemoral reconstruction
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LYON, France — Patients who underwent isolated medial patellofemoral reconstruction exhibited only mild deterioration in Tegner, Lysholm and Kujala scores from 7 years to 16 years follow-up, according to the results of a long-term study presented here.
“Isolated MPFL [medial patellofemoral] reconstruction is effective in stabilizing the patella over a long period. It allows sportsmen to play in sport at the highest level,” Pieter J. Erasmus, MBChB, MMed, of the University of Stellenbosch, South Africa, said during his presentation at the International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Biennial Congress. “Results are stable over a 16-year period. Consider distal tubercle transfer in patients with patella alta.”
Erasmus studied 28 patients who underwent isolated MPFL for recurrent patella dislocation. According to the study abstract, surgeons only corrected the MPFL with the goal of returning it to its original position. The surgeons did not address any other pathology.
Pieter J. Erasmus
During the study, eight patients were lost to follow-up. The average follow-up was 16.6 years, and the average patient age at follow-up was approximately 40 years.
At 7 years’ and 16 years’ follow-up, Tegner scores were 5.8 and 5.5, respectively. At the same follow-up time points, Lysholm score went from 88.5 to 86.9, and the Kujala score decreased from 92.8 to 88.1.
By way of comparison, Erasmus noted the Tegner score for a normal 40-year-old is 5.9, and the Lysholm score is typically 94.
“There was a decrease in activity score at 6 years, but in a way, it’s normal to expect patients to slowly decrease activity, and the score decreased at the same rate as normal knees. If you look at the functional scores, they were stable but below normal,” Erasmus said, noting that primary chondral damage had a statistically significant negative effect on Lysholm scores but no impact on Tegner or Kujala scores. “Patella alta tends to have a lower Kujala score,” he said. However, this finding did not reach statistical significance.
Erasmus noted one redislocation 12 years after the initial surgery in a patient who had a bilateral MPFL reconstruction. A tibial tubercle osteotomy was performed, and the patient is back playing rugby at the same level. – by Gina Brockenbrough, MA
Reference:
Erasmus PJ. Paper #143. Presented at: International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Biennial Congress; June 7-11, 2018; Lyon, France.
Disclosure: Erasmus reports he is an unpaid consultant for and receives research support from Tornier.