scholarly journals Outcomes of Arthroscopic Loose Body Management in Patella Instability: Medial Patellofemoral Ligament Neglect or Repair Versus Reconstruction

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0047
Author(s):  
Alyssa Carroll ◽  
Kristina Johnson Andrew Pennock
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Loose Body ◽  
Recurrent Instability ◽  
Kujala Score ◽  
Second Surgery ◽  
First Time ◽  
Reconstruction Group

Objectives: Patellar instability is common in adolescents during their growth. Management of the actual patellar instability at the time of arthroscopic treatment for concomitant intra-articular loose body has been debated since many surgeons will manage first-time dislocations without surgery. To demonstrate that medial patellofemoral joint reconstruction, rather than neglect or repair of the ligament, should be performed at the time of arthroscopic loose body removal for first-time patellar instability events in children. Methods: Retrospective study design was performed on all patients who sustained a patellar instability event that resulted in an intra-articular loose body between 2011 and 2017 at our institution. Data was collected using ICD-9/10 and/or CPT codes. Patients included in the analysis were required to have a minimum of 24 month follow-up documented. We then performed chart review and radiographic review (XR and MRI). Variables collected included: demographics, weight, BMI, pain score, SANE score, Kujala score, subsequent recurrent instability, need for second surgery, growth plate status, trochlear dysplasia, TT-TG, Insall-Salvati ratio, and Blackburne-Peel ratio. Data analysis pooled the “neglect” and “repair” groups together and compared it to the “reconstruction” group. Continuous variables were examined for normal distribution and homogeneity and analyzed with ANOVA or Mann Whitney. Chi square was utilized for categorical variables. Results: 64 patients (34 males, 30 females) with a mean age at surgery of 14 years (range 9 to 18) met criteria. These participants had a reported mean weight (kg) and BMI of 67.6 kg and 23.9, respectively. In our two-cohort analysis, the reconstruction cohort demonstrated significantly less subsequent instability, with the rate of recurrence being 58.7% in the neglect/repair compared to 16.7% in the reconstruction group (p=0.002). In addition, the reconstruction group demonstrated significantly less patients that required second surgery (p=0.024). The only continuous variable that showed any statistically significant difference was the Insall-Salvati ratio (p=0.048) with the reconstruction group being a mean 1.3 versus a mean 1.4 in the neglect/ repair group. There was no difference was found for age, weight, BMI, Blackburn ratio, TDI, TT-TG, Pain, SANE, Kujala score, satisfaction, or length of follow-up. Conclusion: Medial patellofemoral ligament reconstruction in the setting of adolescent patellar instability with an intra-articular loose body results in significantly less recurrent instability and reduced need for subsequent surgery compared to those who do not undergo a concomitant ligament reconstruction.

scholarly journals OUTCOMES OF ARTHROSCOPIC LOOSE BODY MANAGEMENT IN PATELLA INSTABILITY: MEDIAL PATELLOFEMORAL LIGAMENT NEGLECT OR REPAIR VERSUS RECONSTRUCTION

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0025
Author(s):  
Kristina P. Johnson ◽  
Alyssa N. Carroll ◽  
Andrew T. Pennock
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Loose Body ◽  
Recurrent Instability ◽  
Kujala Score ◽  
Second Surgery ◽  
First Time ◽  
Reconstruction Group

Background: Patellar instability is common in adolescents during their growth. Management of the actual patellar instability at the time of arthroscopic treatment for concomitant intra-articular loose body has been debated since many surgeons will manage first-time dislocations without surgery. Hypothesis/Purpose: To demonstrate that medial patellofemoral joint reconstruction, rather than neglect or repair of the ligament, should be performed at the time of arthroscopic loose body removal for first-time patellar instability events in children. Methods: Retrospective study design was performed on all patients who sustained a patellar instability event that resulted in an intra-articular loose body between 2011 and 2017 at our institution. Data was collected using ICD-9/10 and/or CPT codes. Patients included in the analysis were required to have a minimum of 24 month follow-up documented. We then performed chart review and radiographic review (XR and MRI). Variables collected included: demographics, weight, BMI, pain score, SANE score, Kujala score, subsequent recurrent instability, need for second surgery, growth plate status, trochlear dysplasia, TT-TG, Insall-Salvati ratio, and Blackburne-Peel ratio. Data analysis pooled the “neglect” and “repair” groups together and compared it to the “reconstruction” group. Continuous variables were examined for normal distribution and homogeneity and analyzed with ANOVA or Mann Whitney. Chi square was utilized for categorical variables. Results: 64 patients (34 males, 30 females) with a mean age at surgery of 14 years (range 9 to 18) met criteria. These participants had a reported mean weight (kg) and BMI of 67.6 kg and 23.9, respectively. In our two-cohort analysis, the reconstruction cohort demonstrated significantly less subsequent instability, with the rate of recurrence being 58.7% in the neglect/repair compared to 16.7% in the reconstruction group (p=0.002). In addition, the reconstruction group demonstrated significantly less patients that required second surgery (p=0.024). The only continuous variable that showed any statistically significant difference was the Insall-Salvati ratio (p=0.048) with the reconstruction group being a mean 1.3 versus a mean 1.4 in the neglect/ repair group. There was no difference was found for age, weight, BMI, Blackburn ratio, TDI, TT-TG, Pain, SANE, Kujala score, satisfaction, or length of follow-up. Conclusion: Medial patellofemoral ligament reconstruction in the setting of adolescent patellar instability with an intra-articular loose body results in significantly less recurrent instability and reduced need for subsequent surgery compared to those who do not undergo a concomitant ligament reconstruction.

scholarly journals Outcomes following Medial Patellofemoral Ligament Reconstruction with Allograft (177)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0029
Author(s):  
Danielle Markus ◽  
Eoghan Hurley ◽  
Edward Shontz ◽  
Kirk Campbell ◽  
Laith Jazrawi ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Recurrent Instability ◽  
Vas Score ◽  
Kujala Score ◽  
Patient Reported ◽  
The Mean ◽  
Low Rate

Objectives: Medial patellofemoral ligament reconstruction (MPFLR) using allograft tissue has several potential benefits including the absence of donor site morbidity, ability to predict graft parameters, and decreased operative time. The purpose of this study was to evaluate the outcomes of patients following MPFLR with allograft. Our hypothesis was that there would be a low rate of recurrent instability, and excellent clinical outcomes reported. Methods: A retrospective review of athletes who underwent MPFL Reconstruction, with a minimum of 12-month follow-up was performed. Recurrent instability (including re-dislocation and subluxation), Visual Analogue Scale (VAS) score, Kujala score, satisfaction, and whether they would undergo the same surgery again, were evaluated. Results: Overall, follow up was attained for 131 patients with 141 knees (73.4%). The mean patient age of 25.0 years, 67.4% females, and mean time to follow-up was 46.8 months (12-111). At final follow up, the mean VAS score was 1.4 ± 2.0, the mean Kujala score was 84.8 ± 15.6, the mean satisfaction score was 84% ± 26.0, and 117 (83.0%) would undergo the same procedure again if required. There was 17 (12.0%) patients that had recurrent instability, with 2 being re-dislocations (1.4%). A further procedure was performed in 14 patients (9.9%). There were no intra-operative complications in our series. Conclusions: There was a low rate of recurrent instability following MPFLR with allograft, with excellent patient reported outcomes, and a low complication rate.

scholarly journals Adolescent Medial Patellofemoral Ligament Reconstruction: A Comparison of the Use of Autograft Versus Allograft Hamstring

2018 ◽  
Vol 6 (5) ◽  
pp. 232596711877427 ◽  
Author(s):  
Nikhil Kumar ◽  
Tracey P. Bastrom ◽  
M. Morgan Dennis ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Cruciate Ligament ◽  
Lateral Release ◽  
Return To Sports ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Level Of Evidence ◽  
Significant Difference

Background: Recurrent patellar instability is commonly treated with medial patellofemoral ligament reconstruction (MPFLR), and the use of allograft in anterior cruciate ligament reconstructions has demonstrated inferior outcomes. Purpose: To compare the outcomes of allografts versus autografts in adolescent MPFLR for patellar instability. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was completed on patients younger than 18 years who underwent MPFLR for recurrent instability after failed nonoperative management over an 8-year period with a minimum 2-year follow-up. Patients were divided into autograft or allograft hamstring cohorts for comparison. Primary outcome measures were return to normal activity, incidence of redislocation/subluxation, pain, stiffness, other complications, and Kujala scores. Statistical analysis using unpaired t tests was performed, with an alpha value set at P < .05. Results: After criteria were applied, 59 adolescents (36 allograft, 23 autograft; 38 girls, 21 boys) with a mean ± SD age of 15.2 ± 1.7 years and a mean follow-up of 4.1 ± 1.9 years (allograft, 3.3 ± 1.1 years; autograft, 5.7 ± 2.1 years; P ≤ .001) were included. Seven patients had concurrent osteotomies (3 allograft, 4 autograft), 11 patients had concurrent loose body removals (5 allograft, 6 autograft), and 9 patients had concurrent lateral release (7 allograft, 2 autograft). Between groups, no significant difference was found in change between preoperative and most recent follow-up (mean, 1.2 ± 2.1) or rate of return to sports (mean, 73.3%). In total, 9 surgeries failed (3 allograft, 6 autograft). For the surviving grafts, a statistical difference in mean Kujala scores at final follow-up was noted (allograft, 92.7; autograft, 97.4; P = .02). Conclusion: We identified no significant differences in return to activity, pain score changes, and incidences of failure between patients undergoing MPFLR with allograft versus autograft. Although teenagers with surviving autograft MPFLR reported statistically higher Kujala scores, the mean score difference of 5 points was not clinically significant. It appears that using allograft tendon instead of autograft tissue for MPFLR in this teenage population does not adversely affect long-term outcomes.

scholarly journals Medial patellofemoral ligament reconstruction for patellofemoral instability: a new surgical technique

2021 ◽  
Vol 7 (4) ◽  
pp. 843
Author(s):  
Shreekantha K. S. ◽  
Mohammed Usman ◽  
Deepak Malik ◽  
Mahammad Aseem ◽  
Mohammad Gous Mulla
Keyword(s):  
Surgical Technique ◽  
Functional Outcome ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Patellofemoral Instability ◽  
Lysholm Score ◽  
Mpfl Reconstruction ◽  
Kujala Score ◽  
New Surgical Technique

<p class="abstract"><span lang="EN-US">The purpose of this study was to present new surgical technique for MPFL reconstruction. We also describe its functional outcome, complications, and the advantages of the procedure. This study is a prospective analysis of collected data during the period of august 2018 to January 2020. Ten cases of patients with recurrent symptomatic patellar instability and who underwent isolated MPFL reconstruction were included in the study. Kujala scoring and lysholm scoring was done to assess the functional outcome at follow-up. Post-operative dislocation and apprehension were recorded in each case along with any complication. Pre-operative Kujala score was 36.80 which improved to 89.80 postoperatively at the time follow-up. Pre-operative lysholm score was 36.80 which improved to 92.70 postoperatively at the time follow-up. The improvement in Kujala score and Lysholm score was found to be highly significant (p&lt;0.01). We have done a simple technique where MPFL is reconstructed anatomically to restore kinematics and stability. Consistent good results with early rehabilitation can be obtained using the described technique.</span></p>

scholarly journals Recurrence of Patellar Instability in Adolescents Undergoing Surgery for Osteochondral Defects Without Concomitant Ligament Reconstruction

2018 ◽  
Vol 47 (1) ◽  
pp. 66-70 ◽  
Author(s):  
Jason M. Pedowitz ◽  
Eric W. Edmonds ◽  
Henry G. Chambers ◽  
M. Morgan Dennis ◽  
Tracey Bastrom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Satisfaction ◽  
Patellar Dislocation ◽  
Patellar Instability ◽  
Loose Body ◽  
Secondary Outcome ◽  
Loose Bodies ◽  
Recurrent Instability ◽  
Instability Rate

Background: First-time patellar dislocation with an associated chondral or osteochondral loose body is typically treated operatively to address the loose fragment. The incidence of recurrent instability in this patient population if the medial patellofemoral ligament (MPFL) is not reconstructed is unknown. Purpose: To determine the recurrent instability rate in patients undergoing surgery for patellar instability with chondral or osteochondral loose bodies, as well as to identify and stratify risk factors for recurrent instability. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective analysis of adolescent patients treated operatively for acute patellar dislocation with associated chondral or osteochondral loose bodies between 2010 and 2016 at a single pediatric level I trauma center with minimum 2-year follow-up. Potential demographic, injury-related, radiographic, and surgical risk factors were recorded. The primary outcome variable was recurrent subluxation and/or dislocation. Secondary outcome variables included need for additional procedures, Kujala score, Single Assessment Numerical Evaluation (SANE) score, and patient satisfaction. Results: Forty-one patients were included. In total, 61% experienced recurrent instability at a mean follow-up of 4.1 years and 39% required subsequent MPFL reconstruction. Tibial tubercle-trochlear groove (TT-TG) distance greater than 15 mm was a risk factor for recurrent instability ( P = .03). Patients with TT-TG distance greater than 15 mm and greater than 20 mm had recurrent instability rates of 75% and 86%, respectively. MPFL repair did not reduce the rate of recurrent instability ( P = .87). Recurrent instability was associated with significantly worse mean Kujala (93.9 vs 83.0; P = .01), SANE (88.9 vs 73.1; P = .01), and patient satisfaction scores (9.4 vs 7.3; P = .002). Conclusion: If the MPFL is not reconstructed during index loose body treatment, children have a 61% recurrent instability rate. Patients with TT-TG distance greater than 15 mm, and particularly greater than 20 mm, are at highest risk for recurrent instability.

scholarly journals Long-Term Clinical Results of Double Bundle Reconstruction of the Medial Patellofemoral Ligament for Patellar Instability

2018 ◽  
Vol 32 (02) ◽  
pp. 153-159 ◽  
Author(s):  
Lei Zhang ◽  
Zhiyao Li
Keyword(s):  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Clinical Results ◽  
Double Bundle ◽  
Double Bundle Reconstruction ◽  
Kujala Score ◽  
Lysholm Knee Score ◽  
Lost To Follow Up

Medial patellofemoral ligament (MPFL) reconstruction is a satisfactory technique for patellar instability, and the anatomical double bundle variant is recommended for better clinical results. However, long-term outcomes are still uncharacterized. This study aimed to assess the effectiveness of double bundle reconstruction of the MPFL for patellar instability by means of established scores. A total of 68 patients with chronic patellar instability who underwent surgery from May 2005 to February 2010 were included prospectively. Anatomical double reconstruction of the MPFL with the semitendinosus tendon was conducted. Tegner Activity Scale (TAS), Kujala score, Lysholm knee score, and objective physical examination were assessed during follow-up. Median follow-up time for the patients was 8 (range, 6–10) years. Eight patients were lost to follow-up after 2 years. Preoperative mean TAS was 2.85 ± 0.78, increased to 4.91 ± 0.84 at 6 months and 7.26 ± 0.78 at 2 years postoperatively, and was 7.82 ± 0.89 at last follow-up. At last follow-up, pain free at rest was achieved in all patients; and 8 patients had knee pain in activities of daily living. Mean Kujala score was 57.53 ± 8.59 preoperatively, and increased to 61.22 ± 6.46, 89.51 ± 3.90, and 88.92 ± 3.84 at 6 months, 2 years postoperatively, and at last follow-up, respectively. Lysholm scores were also increased from preoperative values of 43.53 ± 10.20 to 58.22 ± 6.80, 89.37 ± 4.38, and 89.67 ± 4.13 at 6 months, 2 years postoperatively, and at last follow-up, respectively. Range of motion was 121.44 ± 12.69, 129.71 ± 6.39, 130.93 ± 5.67, and 130.78 ± 5.80 at preoperative point, 6 months, 2 years postoperatively, and at last follow-up, respectively. Long-term clinical results of double bundle reconstruction of the MPFL for patellar instability were encouraging.

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 Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Among Patients With Trochlear Dysplasia

2018 ◽  
Vol 46 (4) ◽  
pp. 883-889 ◽  
Author(s):  
Joseph N. Liu ◽  
Jacqueline M. Brady ◽  
Irene L. Kalbian ◽  
Sabrina M. Strickland ◽  
Claire Berdelle Ryan ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Return To Sports ◽  
Medial Patellofemoral Ligament Reconstruction

Background: Medial patellofemoral ligament (MPFL) reconstruction has become one of the most common and widely used procedures to regain stability among patients with recurrent lateral patellar dislocation. While recent studies demonstrated low recurrence rates, improved patient-reported outcome measures, and a high rate of return to sports, limited literature explored its effectiveness as an isolated intervention in the context of trochlear dysplasia. Purpose: To determine the efficacy of isolated MPFL reconstruction in treating patellar instability in the setting of trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective review of consecutive patients who underwent uni- or bilateral medial patellofemoral ligament reconstruction for patellofemoral instability with a minimum 2-year follow-up. No osteotomies were included. Pre- and postoperative assessment included ligamentous laxity, patellar crepitus, tilt, translation, apprehension, and radiographic features, including tibial tubercle-trochlear groove (TT-TG) distance, Dejour classification, and Caton-Deschamps index. Results: A total of 121 MPFL reconstructions were included. Mean age at surgery was 23.8 years, and 4.4 dislocation events occurred before surgery. Mean follow-up was 44 months; 76% of patients were female. Mean preoperative TT-TG ratio was 13.5, and mean Caton-Deschamps ratio was 1.2; 92% of patients had Dejour B, C, or D trochlear dysplasia. Kujala score improved from 55.0 preoperatively to 90.0 ( P < .001). Almost all patients (94.5%) were able to return to sports at 1 year, with 74% returning to the same or higher level of play. Only 3 patients reported a postoperative dislocation or subluxation event. Discussion: For patients without significantly elevated TT-TG distances or significant patella alta, isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, despite the presence of trochlear dysplasia. Most patients are able to return to sports by 1 year postoperatively at the same or higher level of play.

Medial Patellofemoral Ligament Reconstruction for Adolescents With Acute First-Time Patellar Dislocation With an Associated Loose Body

2021 ◽  
pp. 036354652110135
Author(s):  
Pradyuma Gurusamy ◽  
Jason M. Pedowitz ◽  
Alyssa N. Carroll ◽  
Kristina Johnson ◽  
Henry G. Chambers ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Case Series ◽  
Loose Body ◽  
Mpfl Reconstruction ◽  
Return To Sports ◽  
Recurrent Instability ◽  
Patient Reported ◽  
First Time

Background: The management of adolescents with acute first-time patellar dislocation with an associated loose body remains a debated topic. The rate of recurrent dislocation in these patients may be up to 61% if the medial patellofemoral ligament (MPFL) is repaired or not addressed surgically. To our knowledge, a prospective evaluation of MPFL reconstruction for adolescents with acute first-time patellar dislocation with an associated chondral or osteochondral loose body has not been previously performed. Purpose/Hypothesis: The purpose of this study was to analyze patients with a first-time patellar dislocation who required surgery for a loose body, comparing those who underwent MPFL repair or no treatment with those who underwent MPFL reconstruction during the index procedure. The hypothesis was that performing MPFL reconstruction would reduce the rate of recurrent instability and improve patient-reported outcomes compared with MPFL repair or no treatment. A secondary objective was to report outcomes of those patients who underwent reconstruction versus those who did not. Study Design: Case series; Level of evidence, 4. Methods: This was a prospective analysis of adolescents treated with MPFL reconstruction for acute first-time patellar dislocation with associated loose bodies between 2015 and 2017 at a single pediatric level 1 trauma center with minimum 2-year follow-up. Retrospective analysis was previously performed for a similar cohort of adolescents treated with MPFL repair or no treatment. Patient characteristic data, radiographic measurements, and surgical variables were compared. Primary outcome measures included recurrent subluxation or dislocation and the need for further stabilization procedures. Secondary outcomes included Kujala score, Single Assessment Numeric Evaluation score, patient satisfaction, and ability to return to sport. Results: A total of 76 patients were included, 30 in the MPFL reconstruction cohort and 46 in the MPFL repair or no-treatment cohort. The only difference noted in patient characteristic, radiographic, or surgical variables was a smaller Insall-Salvati ratio in the reconstruction group (1.29 vs 1.42; P = .011). Compared with MPFL repair or no treatment, MPFL reconstruction was associated with less recurrent instability (10.0% vs 58.7%; P < .001), fewer secondary procedures (6.7% vs 47.8%; P < .001), and more frequent return to sports (66.7% vs 39.1%; P = .003). No differences in patient-reported outcomes were noted. Conclusion: Performing concomitant MPFL reconstruction in adolescents with first-time patellar dislocation and an intra-articular loose body results in a 5-fold reduction in recurrent instability, reduces the need for subsequent surgery, and improves patients’ ability to return to sports compared with repairing or not treating the MPFL.

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