Return to Play After Medial Patellofemoral Ligament Reconstruction: A Systematic Review

2020 ◽  
pp. 036354652094704
Author(s):  
Amit K. Manjunath ◽  
Eoghan T. Hurley ◽  
Laith M. Jazrawi ◽  
Eric J. Strauss
Keyword(s):  
Systematic Review ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Mpfl Reconstruction ◽  
Return To Play ◽  
Rate Of Return ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Recurrent Instability ◽  
Recurrent Patellar Instability

Background: Medial patellofemoral ligament (MPFL) reconstruction is being performed more frequently in athletes experiencing recurrent patellar instability. Purpose/Hypothesis: The purpose was to systematically review the evidence in the orthopaedic sports medicine literature to determine both the rate and timing of return to play after MPFL reconstruction and the rate of further patellar instability. Our hypothesis was that there would be a high rate of return to play after MPFL reconstruction. Study Design: Systematic review. Methods: A systematic literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which utilized EMBASE, MEDLINE, and the Cochrane Library databases. Inclusion criteria for literature included clinical studies reporting on return to play after MPFL reconstruction. Rate of return to play, level of return, timing of return, rate of recurrent instability, and patient-reported outcomes were evaluated. Statistical analysis was performed using SPSS. Results: Our review found 27 studies including 1278 patients meeting our inclusion criteria. The majority of patients were women (58%), and the total group had a mean age of 22.0 years and a mean follow-up of 39.3 months. The overall rate of return to play was 85.1%, with 68.3% returning to the same level of play. The average time to return to play was 7.0 months postoperatively. The rate of recurrent instability events following reconstruction was 5.4%. There was an improvement in both mean visual analog scale, pain scores (preoperative: 4.3, postoperative: 1.6) and Tegner activity scores (preoperative: 4.8, postoperative: 5.5). Conclusion: The overall rate of return to play was high after MPFL reconstruction for the treatment of recurrent patellar instability. However, a relatively high percentage of those patients were unable to return to their preoperative level of sport. Additionally, there was a moderate time taken to return to play, at approximately 7 months after the procedure.

Return-to-Play Guidelines After Medial Patellofemoral Ligament Surgery for Recurrent Patellar Instability: A Systematic Review

2017 ◽  
Vol 46 (10) ◽  
pp. 2530-2539 ◽  
Author(s):  
Saif Zaman ◽  
Alex White ◽  
Weilong J. Shi ◽  
Kevin B. Freedman ◽  
Christopher C. Dodson
Keyword(s):  
Systematic Review ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Treatment Options ◽  
Mpfl Reconstruction ◽  
Return To Play ◽  
Return To Sports ◽  
Rehabilitation Protocol ◽  
Recurrent Patellar Instability

Background: Medial patellofemoral ligament (MPFL) reconstruction and repair continue to gain acceptance as viable treatment options for recurrent patellar instability in patients who wish to return to sports after surgery. Return-to-play guidelines with objective or subjective criteria for athletes after MPFL surgery, however, have not been uniformly defined. Purpose: To determine whether a concise and objective protocol exists that may help athletes return to their sport more safely after MPFL surgery. Study Design: Systematic review. Methods: The clinical evidence for return to play after MPFL reconstruction was evaluated through a systematic review of the literature. Studies that measured outcomes for isolated MPFL surgery with greater than a 12-month follow-up were included in our study. We analyzed each study for a return-to-play timeline, rehabilitation protocol, and any measurements used to determine a safe return to play after surgery. Results: Fifty-three studies met the inclusion criteria, with a total of 1756 patients and 1838 knees. The most commonly cited rehabilitation guidelines included weightbearing restrictions and range of motion restrictions in 90.6% and 84.9% of studies, respectively. Thirty-five of 53 studies (66.0%) included an expected timeline for either return to play or return to full activity. Ten of 53 studies (18.9%) in our analysis included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. Conclusion: Most studies in our analysis utilized time-based criteria for determining return to play after MPFL surgery, while only a minority utilized objective or subjective patient-centric criteria. Further investigation is needed to determine safe and effective guidelines for return to play after MPFL reconstruction and repair.

scholarly journals CLINICAL OUTCOMES AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION UTILIZING ALLOGRAFT TISSUE IN PEDIATRIC AND ADOLESCENT PATIENTS: MINIMUM 2-YEAR FOLLOW-UP

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0010
Author(s):  
Sachin Allahabadi ◽  
Nirav K. Pandya
Keyword(s):  
Graft Failure ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Mpfl Reconstruction ◽  
Failure Rates ◽  
Recurrent Instability ◽  
Allograft Tissue ◽  
Adolescent Patients ◽  
Recurrent Patellar Instability

Background: Medial patellofemoral ligament (MPFL) reconstruction has gained popularity as a tool to manage recurrent patellar instability. The use of allograft for reconstruction includes benefits of quicker surgical time and obviating donor-site morbidity. In anterior cruciate ligament (ACL) reconstruction hesitancy exists to use allograft in younger patients based on data demonstrating higher graft failure rates. However, a similar trend of allograft failure has not been demonstrated for reconstruction of the MPFL, which has a lower tensile strength than that of the ACL. Hypothesis/Purpose: The purpose of this study is to evaluate outcomes including recurrent instability after MPFL reconstruction utilizing allograft tissue in pediatric and adolescent patients. Methods: A retrospective review was performed to identify patients of a single surgeon with MPFL reconstructions with allograft for recurrent patellar instability with minimum two-year follow-up. Surgical management was recommended after minimum six weeks of nonoperative management including bracing, physical therapy, and activity modification. Pre-operative x-rays were evaluated to assess physeal closure, lower extremity alignment and trochlear morphology, and Insall-Salvati and Caton-Deschamps ratios. MRIs were reviewed to evaluate the MPFL, trochlear morphology, and tibial tubercle trochlear groove distance (TT-TG). The allograft was fixed with a bioabsorbable screw. Descriptive statistics were used to characterize data. The primary outcome was recurrent instability. Results: 20 patients (23 knees) 14 females (17 knees) with average age 15.8 years (range: 11.5-19.6 years) underwent MPFL reconstruction with allograft with average follow-up of 3.6 years (range: 2.2-5.9 years). Physes were open in 8 knees. Average Insall-Salvati ratio was 1.08 ± 0.16 and Caton-Deschamps index was 1.18 ± 0.15. Eighteen patients were noted to have trochlear dysplasia pre-operatively and TT-TG was 15.4 ± 3.9 mm. The three knees (13.0%) with complications had open physes – two (8.7%) had recurrent instability requiring subsequent operation and one sustained a patella fracture requiring open reduction internal fixation. The average Insall-Salvati of these three patients was 1.26 ± 0.21, Caton-Deschamps was 1.18 ± 0.21, and TT-TG was 18.3 ± 3.5mm. There were no growth disturbances noted post-operatively. Conclusion: MPFL reconstruction using allograft tissue may be performed safely in the pediatric and adolescent population with good outcomes at mid-term follow-up with few complications and low rate of recurrent instability. Anatomic factors for may contribute to recurrent instability and complications post-operatively, though larger numbers are needed for statistical analyses. Further prospective and randomized evaluation comparing autograft to allograft reconstruction is warranted to understand graft failure rates.

Clinical Comparison of Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tuberosity Transfer for Recurrent Patellar Instability

2021 ◽  
pp. 036354652110377
Author(s):  
Jong-Min Kim ◽  
Jae-Ang Sim ◽  
HongYeol Yang ◽  
Young-Mo Kim ◽  
Joon-Ho Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Tibial Tuberosity ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Functional Failure ◽  
Radiological Parameters ◽  
Recurrent Patellar Instability

Background: No clear guidelines or widespread consensus has defined a threshold value of tibial tuberosity–trochlear groove (TT-TG) distance for choosing the appropriate surgical procedures when additional tibial tuberosity osteotomy (TTO) should be added to augment medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Purpose: To compare the clinical outcomes between MPFL reconstruction and MPFL reconstruction with TTO for patients who have patellar instability with a TT-TG distance of 15 to 25 mm. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed 81 patients who underwent surgical treatment using either MPFL reconstruction or MPFL reconstruction with TTO for recurrent patellar instability with a TT-TG distance of 15 to 25 mm; the mean follow-up was 25.2 months (range, 12.0-53.0 months). The patients were divided into 2 groups: isolated MPFL reconstruction (iMPFL group; n = 36) performed by 2 surgeons and MPFL reconstruction with TTO (TTO group; n = 45) performed by another 2 surgeons. Clinical outcomes were assessed using the Kujala score, Knee injury and Osteoarthritis Outcome Score, and Tegner activity score. Radiological parameters, including patellar height, TT-TG distance, patellar tilt, and congruence angle were compared between the 2 groups. Functional failure based on clinical apprehension sign, repeat subluxation or dislocation, and subjective instability and complications was assessed at the final follow-up. We also compared clinical outcomes based on subgroups of preoperative TT-TG distance (15 mm ≤ TT-TG ≤ 20 mm vs 20 mm < TT-TG ≤ 25 mm). Results: All of the clinical outcome parameters significantly improved in both groups at the final follow-up ( P < .001), with no significant differences between groups. The radiological parameters also showed no significant differences between the 2 groups. The incidence of functional failure was similar between the 2 groups (3 failures in the TTO group and 2 failures in the iMPFL group; P = .42). In the TTO group, 1 patient experienced a repeat dislocation postoperatively and 2 patients had subjective instability; in the iMPFL group, 2 patients had subjective instability. The prevalence of complications did not differ between the 2 groups ( P = .410). In the subgroup analysis based on TT-TG distance, we did not note any differences in clinical outcomes between iMPFL and TTO groups in subgroups of 15 mm ≤ TT-TG ≤ 20 mm and 20 mm < TT-TG ≤ 25 mm. Conclusion: MPFL reconstruction with and without TTO provided similar, satisfactory clinical outcomes and low redislocation rates for patients who had patellar instability with a TT-TG distance of 15 to 25 mm, without statistical difference. Thus, our findings suggest that iMPFL reconstruction is a safe and reliable treatment for patients with recurrent patellar dislocation with a TT-TG distance of 15 to 25 mm, without the disadvantages derived from TTO.

scholarly journals Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability in Skeletally Immature versus Mature Patients

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0047
Author(s):  
Simone Gruber ◽  
Rhiannon Miller ◽  
Beth Shubin Stein ◽  
Joseph Nguyen
Keyword(s):  
Growth Plate ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Return To Sport ◽  
Mpfl Reconstruction ◽  
Skeletally Immature ◽  
Immature Group ◽  
Chi Square Analysis ◽  
Recurrent Patellar Instability ◽  
Mature Population

Objectives: Medial patellofemoral ligament (MPFL) reconstruction is the standard of care surgical treatment for recurrent patellar instability. Recurrent patellar instability is common after a first-time dislocation in the skeletally immature population. Adult-type reconstruction techniques are often avoided in skeletally immature patients due to the proximity of the femoral insertion of the MFPL to the distal femoral physis. It is currently unclear how outcomes of MPFL reconstruction in skeletally immature patients compare to those for skeletally mature patients. The objective of this study is to present the outcomes of isolated MPFL reconstruction in skeletally immature patients and compare their findings to a skeletally mature population. Methods: Patients were identified from an institutional patellofemoral registry who underwent isolated MPFL reconstruction from March 2014 to July 2018. Demographic, radiographic, and knee-specific patient-reported outcome measures (PROMs) were collected prior to surgery. Follow-up data collection included knee surveys collected at 1 and 2-years following MPFL reconstruction. Additionally, return to sport rates and episodes of re-dislocations were also collected. Comparisons of demographic and clinical data were made between skeletally immature and mature patients. Sub-analysis was performed on outcomes in skeletally immature patients who underwent MPFL reconstruction where the graft was placed distal to the physis to avoid the growth plate versus those who had standard placement of the graft. Baseline factors were analyzed using independent samples t-tests or chi-square analysis. Longitudinal analysis of knee PROMs was conducted using generalized estimating equation (GEE) modeling. Statistical significance was defined as p-values of 0.05 or less. Results: The study cohort included 107 patients (25 skeletally immature, 82 skeletally mature). Mean age of the study groups was 13.8 years in the immature group (range 11-15) and 21.3 in the mature group (range 14-34). No differences in sex (72% female in both groups) or obesity (0% vs. 8%) was observed between immature and mature patients. Radiographic measures of Caton-Deschamps Index (1.18 in both groups), TT-TG (14.9 vs. 14.8), and Dejour classification (P=0.328) also saw no differences between groups. Longitudinal outcomes in KOOS QoL, IKDC, KOOS PS, and Kujala surveys found no differences between immature versus mature patients over time. However, higher PediFABS was observed in the immature group versus mature at baseline (21.6 vs. 11.9, P<0.001), 1-year (18.1 vs. 11.5, P=0.006), and 2-years (22.4 vs. 11.5, P=0.003). Low incidence of post-operative dislocation and a high return to sport rate was observed in both skeletally immature and mature patients. No statistical differences were observed in all outcomes between immature patients who had standard graft placement and those where the graft was placed distal to the physis. Conclusion: Controversy exists in how best to treat the skeletally immature patient with recurrent lateral patellar instability. Due to the risk of injury to the growth plate, many believe it is best to wait to stabilize these patients until they have stopped growing. However, given the high risk of cartilage injury with each dislocation and the long term sequelae of such injuries in these young knees, the risk of waiting may be high. This study demonstrates similar outcomes and recurrence rates in skeletally immature patients with those seen in the mature population without disturbance or injury to the growth plates. [Figure: see text][Figure: see text]

scholarly journals Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985321 ◽  
Author(s):  
John W. Belk ◽  
Matthew J. Kraeutler ◽  
Omer Mei-Dan ◽  
Darby A. Houck ◽  
Eric C. McCarty ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Intervention ◽  
Return To Sport ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Return To Play ◽  
Rate Of Return ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Proximal Hamstring

Background: Previous studies have evaluated functional outcomes and return-to-sport rates after proximal hamstring tendon (HT) repair. Purpose: To systematically review the literature in an effort to evaluate return-to-sport rates after proximal HT repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that evaluated postoperative lower extremity function and return-to-sport rates in patients after proximal HT repair. Search terms used were “hamstring,” “repair,” “return to sport,” and “return to play.” Patients were assessed based on return to sport, return to preinjury activity level, type of HT tear (complete or partial), and interval from injury to surgery. Patients were also divided into subgroups depending on timing of the surgical intervention: early, <1 month; delayed, 1 to 6 months; and late, >6 months from the time of injury. Results: Sixteen studies (one level 2, five level 3, ten level 4) met the inclusion criteria, including 374 patients with a complete proximal HT tear (CT group) and 93 patients with a partial proximal HT tear (PT group), with a mean follow-up of 2.9 years. Overall, 93.8% of patients (438/467) returned to sport, including 93.0% (348/374) in the CT group and 96.8% (90/93) in the PT group ( P = .18). The mean time to return to sport was 5.7 months, and 83.5% of patients (330/395) returned to their preinjury activity level. The early group demonstrated the greatest rate of return to sport at 94.4% (186/197) as well as the quickest time to return at a mean of 4.8 months, although this was not found to be statistically significant. Conclusion: Over 90% of patients undergoing repair of a complete or partial proximal HT tear can be expected to return to sport regardless of the tear type. Early surgical interventions of these injuries may be associated with a quicker return to sport, although the rate of return to sport does not differ based on timing of the surgical intervention.

scholarly journals Comparing Sex-Specific Outcomes After Medial Patellofemoral Ligament Reconstruction for Patellar Instability: A Systematic Review

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110581
Author(s):  
A.J. Fancher ◽  
A.J. Hinkle ◽  
M.L. Vopat ◽  
K. Templeton ◽  
A. Tarakemeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Cochrane Library ◽  
Male And Female ◽  
Female Patients ◽  
Secondary Purpose ◽  
The Impact

Background: The impact of patient sex on outcomes after medial patellofemoral ligament ligament reconstruction (MPFLR) has not been well studied. Purpose: To conduct a systematic review to determine sex-based differences in outcomes after MPFLR for patellar instability and the proportion of studies examining this as a primary or secondary purpose. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using the PubMed, Cochrane Library, PubMed Central, Ovid, and Embase databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were written in English, were performed on humans, consisted of patients who underwent MPFLR with allograft or autograft, evaluated at least 1 of the selected outcomes comparing male and female patients, and had statistical analysis available for relevant findings. Excluded were case reports, review studies or systematic reviews, studies that did not evaluate at least 1 sex-specific outcome, studies that included other injuries associated with patellofemoral instability injury, cadaveric studies, and those in which patients underwent concomitant procedures. Results: The initial search yielded 3470 studies; 2647 studies remained after removing duplicates. Of the 401 studies that underwent full-text review, 10 met all inclusion criteria and were included for quantitative analysis. A meta-analysis could not be performed given the heterogeneity within the data set. Of the 2647 studies evaluated in this study, only 2 (0.08%) studies examined the impact of patient sex on MPFLR outcomes as a primary purpose and only 8 (0.30%) studies explored it as a secondary purpose. Conclusion: Only 0.38% of the articles compared outcomes between male and female patients after MPFLR. The limited data available were too heterogenous to draw any concrete conclusions about the impact of patient sex on outcomes after MPFLR. Further research in this area is warranted, as findings may influence treatment plans and improve patient outcomes.

scholarly journals Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of the Tibial Tubercle Trochlear Groove Distance: Outcomes at 1 and 2 Years

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0007
Author(s):  
Brandon J. Erickson ◽  
Joseph Nguyen ◽  
Katelyn Gasik ◽  
Jacqueline Brady ◽  
Beth E. Shubin Stein
Keyword(s):  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellar Height ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
One Year ◽  
Recurrent Patellar Instability

Background: Several surgical options exist for treatment of recurrent patellar instability. The treatments can be divided into ligamentous and bony procedures. It is currently unclear which patients require a bony procedure in addition to a soft tissue reconstruction. Purpose: To report the one and two-year outcomes of patients following medial patellofemoral ligament (MPFL) reconstruction performed in isolation regardless of the patellar height, tibial tubercle trochlear groove distance (TT-TG) or trochlear dysplasia. Hypothesis:: Patients will have <5% re-dislocation rate and significant improvements in patient reported outcome measures (PROMs) following isolated MPFL reconstruction. Methods: All patients with recurrent patellar instability and without significant unloadable chondral defects, failed previous surgery or pain greater than or equal to 50% as their chief complaint, were prospectively enrolled beginning March of 2014. All patients underwent a primary, unilateral, isolated MPFL reconstruction regardless of concomitant bony pathology for treatment of recurrent patellar instability. Patients were followed at standard intervals. PROMs were collected at one year and two year follow up visits. Information on recurrent subjective instability, dislocations, and ability to return to sport (RTS) was recorded. TT-TG and patellar height (using the Caton-Deschamps index) were measured on magnetic resonance images. Results: Overall, 90 patients (77% female; average age 19.4 +/- 5.6 years) underwent a MPFL reconstruction from March 2014 to August 2017; 63 (70%) of whom reached one year follow up, and 35 of these patients (39%) reached 2-year follow-up. No patient experienced a redislocation; 96% of patients at one year and 100% of patients at two years had no subjective patellofemoral instability. RTS rates at one and two years were 59% and 75% respectively. No patient experienced a complication at one year. All patients had a clinically and statistically significant improvement from baseline to 1-year follow-up in the following PROMs: Knee injury and Osteoarthritis Outcome Score Quality of Life (KOOS QOL) (32.7 to 72.0; p<0.001), International Knee Documentation Committee (IKDC) (51.4 to 82.6; p<0.001) Kujala (62.2 to 89.5; p<0.001), and all general health PROM. No clinically and statistically significant change was seen between 1- and 2-year follow-ups in all outcome scores (all p>0.05). A non-statistically significant increase was seen in sporting activity of the Pediatric Functional Activity Brief Scale (Pedi-FABS) (13.9 to 16.7 p=0.292) at 2 years. Average patient satisfaction was 9.3 of 10 (10 being most satisfied) at 1- and 2-year follow-up. Average TT-TG was 15.1 +/- 4.0. Average patellar height was 1.25 +/- 0.17. Conclusion: Isolated MPFL reconstruction is an effective treatment for patellar instability and provides significant improvements in PROMs with a low redislocation/instability rate at early 1 and 2 year follow up, regardless of bony pathologies including TT-TG, Caton-Deschamps Index and trochlear dysplasia. The goal of this ongoing prospective study is to follow these patients out for 5 to 10 years to assess what radiologic and physical examination factors predict failure of isolated MPFL reconstruction.

scholarly journals Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis

2019 ◽  
Vol 7 (7) ◽  
pp. 232596711985502 ◽  
Author(s):  
Alan G. Shamrock ◽  
Molly A. Day ◽  
Kyle R. Duchman ◽  
Natalie Glass ◽  
Robert W. Westermann
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Medial Patellofemoral Ligament ◽  
Donor Site ◽  
Mpfl Reconstruction ◽  
Complication Rates ◽  
Skeletally Immature ◽  
Recurrent Instability ◽  
Femoral Fixation

Background: Given the proximity of the medial patellofemoral ligament (MPFL) femoral insertion to the distal femoral physis in skeletally immature patients, multiple techniques for femoral graft fixation have been described. Purpose: To systematically review the literature and evaluate outcomes and complications following MPFL reconstruction in skeletally immature patients. Study Design: Systematic review; Level of evidence, 4. Methods: A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines through use of the PubMed, Embase, and Cochrane Central databases. All original, English-language studies reporting outcomes or complications following MPFL reconstruction in skeletally immature patients were included. Skeletally mature patients were excluded. Data regarding demographics, surgical technique, graft type, outcomes, and complications were recorded. Study quality was assessed by use of the modified Coleman methodology score. Statistical analysis was performed through use of chi-square and weighted mean pooled cohort statistics, where appropriate, with significance set at P < .05. Results: 7 studies that entailed 132 MPFL reconstructions (126 patients) met the inclusion criteria. Females comprised 57.9% of the cohort (73 females), and the mean age was 13.2 years (range, 6-17 years). Mean postoperative follow-up was 4.8 years (range, 1.4-10 years). All of the grafts used were autograft, with gracilis tendon (n = 80; 60.6%) being the most common. Methods of femoral fixation included interference screw (n = 52; 39.4%), suture anchor (n = 51; 38.6%), and soft tissue pulley around the medial collateral ligament or adductor tendon (n = 29; 21.9%). Pooled Kujala scores improved from 59.1 to 84.6 after MPFL reconstruction. The total reported complication rate was 25.0% (n = 33) and included 5 redislocations (3.8%) and 15 subluxation events (11.4%). No cases of premature physeal closure were noted, and there were 3 reports of donor site pain (2.3%). Neither autograft choice ( P > .804) nor method of femoral fixation ( P > .416) influenced recurrent instability or overall complication rates. Conclusion: These findings suggest that MPFL reconstruction in skeletally immature patients is a viable treatment option, with significant improvement in patient-reported outcomes and redislocation event rates of less than 5% at nearly 5-year follow-up. Further high-quality research is needed to determine optimal graft options and surgical technique while considering recurrent instability, donor site morbidity, and potential injury to the adjacent physis.

Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of Tibial Tubercle–Trochlear Groove Distance and Patellar Height: Outcomes at 1 and 2 Years

2019 ◽  
Vol 47 (6) ◽  
pp. 1331-1337 ◽  
Author(s):  
Brandon J. Erickson ◽  
Joseph Nguyen ◽  
Katelyn Gasik ◽  
Simone Gruber ◽  
Jacqueline Brady ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellar Height ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Outcome Scores ◽  
Recurrent Patellar Instability

Background: It is unclear which patients with recurrent patellar instability require a bony procedure in addition to medial patellofemoral ligament (MPFL) reconstruction. Purpose: To report 1- and 2-year outcomes of patients after isolated MPFL reconstruction performed for patellar instability regardless of patellar height, tibial tubercle–trochlear groove (TT-TG) distance, or trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: All patients with recurrent patellar instability and without significant unloadable chondral defects (Outerbridge grade IV), cartilage defects (especially inferior/lateral patella), previous failed surgery, or pain >50% as their chief complaint were prospectively enrolled beginning March 2014. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of concomitant bony pathology for treatment of recurrent patellar instability. Information on recurrent subjective instability, dislocations, ability to return to sport (RTS), and outcome scores was recorded at 1 and 2 years. TT-TG distance, patellar height (with the Caton-Deschamps index), and trochlear depth were measured. Results: Ninety patients (77% female; mean ± SD age, 19.4 ± 5.6 years) underwent MPFL reconstruction between March 2014 and August 2017: 72 (80%) reached 1-year follow-up, and 47 (52.2%) reached 2-year follow-up (mean follow-up, 2.2 years). Mean TT-TG distance was 14.7 ± 5.4 mm (range, –2.2 to 26.8 mm); mean patellar height, 1.2 ± 0.11 mm (range, 0.89-1.45 mm); and mean trochlear depth, 1.8 ± 1.4 mm (range, 0.05-6.85 mm). Ninety-six percent of patients at 1 year and 100% at 2 years had no self-reported patellofemoral instability; 1 patient experienced a redislocation at 3.5 years. RTS rates at 1 and 2 years were 90% and 88%, respectively. Mean time to RTS was 8.8 months. All patients had clinically and statistically significant improvement in mean Knee injury and Osteoarthritis Outcome Score–Quality of Life (32.7 to 72.0, P < .001), mean International Knee Documentation Committee subjective form (51.4 to 82.6, P < .001), and mean Kujala score (62.2 to 89.5, P < .001). No difference existed between 1- and 2-year outcome scores (all P > .05). Conclusion: At early follow-up of 1 and 2 years, isolated MPFL reconstruction is an effective treatment for patellar instability and provides significant improvements in outcome scores with a low redislocation/instability rate regardless of bony pathologies, including TT-TG distance, Caton-Deschamps index, and trochlear dysplasia. Future data from this cohort will be used to assess long-term outcomes.

Return to Play After the Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review

2019 ◽  
Vol 47 (12) ◽  
pp. 3002-3008 ◽  
Author(s):  
Eoghan T. Hurley ◽  
Connor Montgomery ◽  
M. Shazil Jamal ◽  
Yoshiharu Shimozono ◽  
Zakariya Ali ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Return To Play ◽  
Rate Of Return ◽  
Cochrane Library ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Latarjet Procedure ◽  
Recurrence Rates ◽  
Overhead Athletes

Background: Traumatic anterior shoulder instability is a common clinical problem among athletic populations. The Latarjet procedure is a widely used treatment option to address shoulder instability in high-demand athletes at high risk of recurrence. However, rates and timing of full return to sports have not been systematically analyzed. Purpose: To systematically review the evidence in the literature to ascertain the rate and timing of return to play and the availability of specific criteria for safe return to play after the Latarjet procedure. Study Design: Systematic review. Methods: A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the EMBASE, MEDLINE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on return to play after the Latarjet procedure. Statistical analysis was performed by use of SPSS. Results: Our review found 36 studies including 2134 cases meeting our inclusion criteria. The majority of patients were male (86.9%), with a mean age of 25.4 years (range, 15-59 years) and a mean follow-up of 83.5 months. The overall rate of return to play was 88.8%, with 72.6% returning to the same level of play. Among collision athletes, the overall rate of return to play was 88.2%, with 69.5% returning to the same level of play. In overhead athletes, the overall rate of return to play was 90.3%, with 80.6% returning to the same level of play. The mean time to return to play was 5.8 months (range, 3.2-8 months). Specific return to play criteria were reported in the majority of the studies (69.4%); time to return to sport was the most commonly reported item (66.7%). Conclusion: The overall rate of return to play was reportedly high after the Latarjet procedure. However, almost a fifth of athletes returning to sports were not able to return at the same level. Further development of validated criteria for safe return to sports could potentially improve clinical outcomes and reduce recurrence rates.

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