MPFL reconstruction is preferred for pediatric patellar dislocations with a loose body
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Medial patellofemoral ligament reconstruction increased stability in adolescent patients with an acute, first-time patellar dislocation and an associated chondral or osteochondral loose body, according to presented results.
“When you have a loose body, particularly if it is bigger than a centimeter squared, then you should probably do surgery to remove it or to fix it,” Eric W. Edmonds, MD, an orthopedic researcher and sports medicine specialist at Rady Children’s Hospital in San Diego, said in his presentation at the Pediatric Orthopaedic Society of North America Annual Meeting. “The question becomes: What do you do with the MPFL?”
Edmonds and colleagues analyzed 76 adolescent patients (mean age of 14 years) with a first-time patellar dislocation and an associated chondral or osteochondral loose body. Researchers performed a prospective analysis of 30 patients who underwent MPFL reconstruction and compared the results with a retrospective analysis of 46 patients who underwent either MPFL repair or had no intervention. According to the study abstract, outcome measures included recurrent subluxation or dislocation, Kujala score, SANE score, patient satisfaction and return to sport.
Edmonds and colleagues found no significant differences in patient-reported outcomes (PROs); however, they found that compared with the repair or no treatment cohort, the reconstruction cohort had fewer cases of recurrent instability (10% vs. 58.7%), fewer secondary procedures (6.7% vs. 47.8%) and more patients returned to sports.
“In the end, you can do an [MPFL] reconstruction and improve [the recurrent instability rate] by fivefold – just by doing the reconstruction at that time,” Edmonds said. “In doing that, you don’t change their PROs.”
“In conclusion, we would recommend doing MPFL reconstruction in the setting of those first-time dislocators with an osteochondral fragment vs. a ‘do nothing or repair’ of that ligament,” he added.
Perspective
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The authors of paper 128, presented at the POSNA meeting on May 14, 2021, described their results of treating adolescents who sustained patellar dislocations and needed loose body removal with MPFL reconstruction, MPFL repair or no MPFL surgery. In their abstract, Eric Edmonds, MD, and co-authors present a retrospective review of 76 adolescents with a minimum 2-year follow-up treated with arthroscopic loose body removal. Thirty of 76 patients underwent concomitant MPFL reconstruction, while 46 underwent MPFL repair or no MPFL treatment. The patients who underwent MPFL reconstruction had less recurrent instability (10% vs. 58.7%) and more frequently were able to return to sports (66.7% vs. 39.1%) than those who had MPFL repair or no treatment.
The findings reported in this abstract seem to reinforce the growing body of literature that supports MPFL reconstruction over MPFL repair for patellar instability. Furthermore, it suggests a role for formal patellar stabilization following a single instability episode when a loose body removal is indicated. I look forward to reading the full manuscript once it is published.
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Edmonds EW, et al. Paper 128. Presented at: Pediatric Orthopaedic Society of North America Annual Meeting; May 12-15, 2021; Dallas (hybrid meeting).
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