More than two patellar dislocations prior to MPFL reconstruction linked with poor outcomes
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COLORADO SPRINGS, Colo. — Patients with more than two patellar dislocations prior to medial patellofemoral ligament reconstruction experienced worse patient-reported outcomes compared with patients who had two or less dislocations.
“One could hypothesize that history of multiple dislocations is likely associated with more damage to soft tissue structures, and we know from prior anatomic work that the medial patellofemoral ligament (MPFL) is not the only soft tissue stabilizer of the patella,” Robert A. Magnussen, MD, said in his presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting. “So isolated MPFL reconstruction may be less effective for patients with multiple dislocations stretching their soft tissue structures.”
Magnussen and colleagues analyzed 95 patients who underwent isolated MPFL reconstruction at a single U.S. academic institution between 2008 and 2016 with mean follow-up of 4.8 years. According to the abstract, patients who underwent concomitant tibial tubercle osteotomy or fixation of an osteochondral fracture were excluded from the study. Number of prior patellar dislocations, Caton-Deschamps index, tibial tubercle-trochlear groove distance and trochlear sulcus angle were noted for all patients. Patient-reported outcomes included the Norwich Patellar Instability (NPI) score, KOOS scores and Marx activity score.
After controlling for demographic and anatomical factors, Magnussen and colleagues found patients with more than two dislocations had lower KOOS pain, activities of daily living, sport/recreation and knee-related quality of life subscale scores compared with patients who had two or less dislocations.
“I think it might be interesting to focus on those patients with multiple dislocations — similar to the way in ACL research we often focus on the highest risk patients, like adolescents, when evaluating potential predictors of outcomes,” Magnussen said.
“Looking at this group, we may be able to identify some additional factors that can influence the outcome of isolated MPFL reconstruction,” he concluded.
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Magnussen RA, et al. Paper 51. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 13-17, 2022; Colorado Springs, Colo.
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