Medial patellofemoral complex reconstruction may be warranted for first-time dislocation
Key takeaways:
- Combined MPFL and medial quadriceps tendon femoral ligament reconstruction yielded fewer failures vs. nonoperative treatment.
- Researchers cautioned about the increased complication rates associated with surgery.
Results showed combined medial patellofemoral ligament and medial quadriceps tendon femoral ligament reconstruction may yield improved outcomes for skeletally immature patients with first-time dislocations vs. nonoperative treatment.
However, due to increased complication rates and potential morbidity associated with surgery, appropriate patient selection and identification of risk factors is important.
“Our findings suggest a significant advantage for operative management in terms of clinical failure rates and functional outcomes, aligning with emerging evidence supporting surgical intervention in this population, when risk factors for recurrence are present,” Kristen Reikersdorfer, BA, medical student at Harvard Medical School, and colleagues wrote in the study.
Reikersdorfer and colleagues analyzed data from a consecutive retrospective cohort of skeletally immature patients (mean age, 11.8 years) with first-time patellofemoral dislocations who were indicated for treatment and had minimum 2-year follow-up.
Overall, 90 patients received nonoperative treatment of bracing and physical therapy and 52 patients underwent combined MPFL and medial quadriceps tendon femoral ligament (MQTFL) reconstruction.
According to the study, outcome measures included failures, defined as subsequent dislocations or subluxations; Kujala scores; IKDC scores; Tegner activity level and return to sport.
At 2 years, 15.4% of the operative group and 58.8% of the nonoperative group had clinical failure. Among the operative group, four patients (7.7%) had a subsequent dislocation; three patients (5.8%) had a subluxation and one patient (1.9%) had subjective instability. Among the nonoperative group, 44 patients (48.9%) had a subsequent dislocation and eight patients (8.9%) had a subluxation.
Reikersdorfer and colleagues found patients who underwent combined MPFL and MQTFL reconstruction had significantly higher Kujala scores (91.5 vs. 82.5), IKDC scores (89 vs. 78.4), Tegner activity scores (6 vs. 4), rates of return to sport (88.5% vs. 66.2%) and rates of return to the same activity level (91.3% vs. 69.6%). However, the complication rate was significantly higher in the operative group (11.5%) vs. the nonoperative group (1.1%).
Reikersdorfer and colleagues urged surgeons to consider the risk factors of both techniques when making surgical decisions for patients with patellar instability.
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