Unilateral MPFL reconstruction yielded higher return to sport rates vs. bilateral surgery
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Key takeaways:
- Unilateral medial patellofemoral ligament reconstruction was associated with higher return to sport rates vs. bilateral reconstruction.
- Fear of reinjury was commonly cited for not returning to sport.
Return to sport rates were higher for pediatric athletes who underwent unilateral medial patellofemoral ligament reconstruction compared with bilateral MPFL reconstruction, according to published results.
Michael P. Klueh, MD, and colleagues from the University of Michigan performed a matched cohort study of data from pediatric athletes who underwent bilateral (n = 16; mean age of 14 years) vs. unilateral (n = 32; mean age of 14.3 years) MPFL reconstruction for recurrent patellofemoral instability.
According to the study, outcome measures included overall return to sport rates, level of play after returning to sport, reason for not returning to sport, single assessment numeric evaluation (SANE) scores and Caton-Deschamps index.
Klueh and colleagues found 69% of patients in the bilateral cohort and 94% of patients in the unilateral cohort returned to sport by 1 year. Among athletes who returned to sport, 81% of the bilateral cohort and 67% of the unilateral cohort achieved the same or higher level of play.
Among athletes in the bilateral cohort who did not return to sport, 57% reported fear of reinjury as the primary reason for not returning to sport.
Researchers noted no differences between the cohorts regarding postoperative complications or SANE scores. However, they found the bilateral cohort had a statistically significantly higher Caton-Deschamps index compared with the unilateral cohort (1.3 vs. 1.2, respectively).
“Future work should be aimed at confirming these findings using a prospective study design and determining causes for lower return to sport rates after bilateral MPFL reconstruction as potential targets for intervention,” Klueh and colleagues wrote in the study.
Perspective
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Daniel W. Green, MD, MS, FAAP, FACS
This study aimed to assess bilateral return to sport rates and patients’ outcomes when compared to a unilateral MPFL reconstruction cohort.
This was a prospective collection of return to sport data on retrospectively identified patients, aged 18 years and younger, who either underwent unilateral or bilateral MPFL reconstruction. Patients undergoing unilateral and bilateral MPFL reconstruction were matched 2:1, respectively. Patient-reported outcomes were recorded from SANE, and preoperative imaging and postoperative complications were also collected.
After matching 16 patients undergoing bilateral MPFL reconstruction with 32 patients undergoing unilateral MPFL reconstruction, the authors found a significant decrease in return to sport rates for patients undergoing bilateral MPFL reconstruction (P = .03).
For patients who did return to sport (both cohorts), there was no difference in level played. For bilateral MPFL reconstruction patients who did not return to sport or returned to sport at a lower level, 57% claimed fear of reinjury as their reasoning.
There were no differences in postoperative complications or SANE score. Interestingly the bilateral MPFL reconstruction cohort had a slightly higher alta.
As one might suspect, this paper shows that patients with bilateral patella MPFL reconstruction have a lower return to sport than unilateral cases. However, this paper also clearly reveals that the majority of MPFL patients do return to sport, whether the surgery was unilateral (94%) or bilateral (63%).
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