Study finds high rate of return to sport after MPFL reconstruction
Patients undergoing medial patellofemoral ligament reconstruction for patellar instability can expect a high rate of return to sport with or without concomitant osteotomy, according to published results.
Brooks N. Platt, MD, and colleagues performed a systematic review of 23 articles that included 930 patients - 786 of which were athletes - who underwent medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation.
“A random-effects model was used to evaluate return to sport rates, subsequent level, and rate of instability recurrence,” the researchers wrote in the study. “Meta-regression was used to compare return to sport rates in patients undergoing MPFL reconstruction without osteotomy compared with those treated with simultaneous tibial tubercle osteotomy or trochleoplasty,” they added.
Overall, patients returned to sport at a mean of 6.7 months after surgery with an 8.8% complication rate, according to the study. Preoperative to postoperative Kujala scores were 60.3 and 90, respectively.
Platt and colleagues found a return to sport rate of 92.8% and noted patients returned to or surpassed their preoperative level of activity in 71.3% of all cases. Additionally, researchers noted no differences between patients who received an additional osteotomy (10.5% of patients) vs. those who did not.
“Overall, these findings support MPFL reconstruction as an effective surgical treatment for athletes with recurrent patellar dislocation,” they wrote. “Surgeons can counsel their patients that they can expect a high rate of return to sport after MPFL reconstruction surgery alone or with concomitant osteotomy.”
Perspective
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In this systematic review and meta-analysis, Platt and colleagues reported a 92.8% rate of return to sport (RTS) at 3 years, with 71.3% returning to their prior level of sport after MPFL reconstruction. Although considerable variability exists between surgical techniques, this study overall demonstrated favorable results that reflect the reliability of MPFL reconstruction for treating patellar instability in athletes. The authors also reported no significant difference in RTS rates between the osteotomy group (as defined by concurrent tuberosity osteotomy or trochleoplasty) vs. MPFL reconstruction alone. It is important to note that this does not equate the two surgical approaches, but rather highlights the importance of appropriate surgical indications based on patient-specific characteristics.
As the authors nicely stated, improving our understanding of the degree of anatomic variation that can be tolerated without a combined procedure remains an important area of future study. Additional considerations of variations in MPFL graft position, fixation types and graft length or tensioning techniques, will be crucial in optimizing outcomes and sports-related function in patients who undergo patellar stabilization surgery.
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