Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation

Abstract

Purpose The purpose of this study was to measure the improvement in quality of life (QoL) following isolated anatomical double-bundle medial patellofemoral ligament reconstruction. Methods This is a single-centre, prospective study of 56 consecutive patients (57 knees) who underwent isolated MPFL reconstruction between 2014 and 2017. Functional outcome and QoL were assessed with the Kujala score and the EQ-5D-3L questionnaire, respectively. Objective outcomes were obtained through clinical examination at the latest follow-up assessing redislocation rate, patella apprehension test, patellar tilt, pain and range of motion. ResultsThe median Kujala score increased from 60 (range 31-96) to 92 (range 34-100) at latest follow-up (p < 0.001). The median EQ-5D index also increased, from 0.69 (range 0.10-1) at baseline to 1 (range 0.16-1) at latest follow-up (p < 0.001), as well as the median EQ-5D VAS from 75 (range 20-95) to 92 (range 40-100) (p < 0.001). Four dimensions of the EQ-5D were signiicantly improved except for the anxiety/depression scores. Female patients reported lower scores at baseline and at latest follow-up, for all three outcomes (Kujala, EQ-5D index, EQ-5D VAS), however there was no evidence that gender negatively impacted on the beneit of surgery. The re-dislocation rate was 0%. Apprehension and patellar tilt test were negative in all patients and no lexion deicit was identiied at latest follow-up. Two patients had tenderness along the reconstruction requiring femoral screw removal in one of them. Conclusions Isolated anatomical double-bundle aperture MPFL reconstruction, ofered signiicantly improved short-term QoL along with excellent functional outcome. Female patients scored lower, but this did not afect the overall outcome. Including QoL tools in the assessment of ligament reconstruction operations, such as the MPFL, can provide more accurate understanding of the overall patient beneit. Level of evidence II.

Complex patellofemoral reconstruction leads to improved physical and sexual activity in female patients suffering from chronic patellofemoral instability

“…It must be noted, however, that QoL includes multidimensional aspects and can be affected by the patient’s emotional and physical health, functional ability, and social environment [ 17 ]. Other studies assessed QoL after isolated MPFL-R with the EQ-5D-3L score [ 4 , 5 ]. After a comparable follow-up period, Biesert et al described a mean EQ-5D-3L VAS of 70 and an EQ-5D-3L Index of 0.78 in a Swedish cohort [ 4 ].…”

“…Over the last years, research on PFI has mainly focused on functional outcomes [ 1 , 4 , 13 , 14 , 24 , 26 , 35 , 44 ], re-dislocation rates [ 10 , 12 , 15 , 18 , 43 ], and return to sports [ 30 , 36 , 45 ]. Recently, research concerning Quality of Life (QoL) after MPFL-R has gained more attention [ 4 , 5 , 17 , 19 , 21 , 22 ]. Patient-reported QoL outcome measures are commonly seen as multi-dimensional and can therefore be influenced through a range of domains [ 23 ].…”

Clinical Outcomes and Prognostic Factors in Patients With Recurrent Patellar Lateral Dislocation Treated With Isolated Medial Patellofemoral Ligament Reconstruction: A Retrospective Single-Center Analysis

“…27 MPFLR has become the most practical means for treating knee instability, and it has been frequently used for its ideal outcomes and relatively low rate of complications. 30 The majority of researchers have concluded that MPFLR alone could achieve reliable outcomes even in patients with bony deformity, 2,3,8,9,13,18,39 while others believe that it may be insufficient with isolated soft tissue surgery. 1,14,34 However, no consensus has been reached concerning when a concomitant bony procedure should be added to strengthen the MPFLR.…”

Preoperative Complete Patellofemoral Dislocation in Extension Predicts an Inferior Clinical Outcome After Medial Patellofemoral Ligament Reconstruction in Patients With Recurrent Patellar Dislocation

“…Over the past decade, medial patellofemoral ligament (MPFL) reconstruction (MPFL-R) has been considered the most effective treatment for recurrent patellar dislocation (RPD), with a low redislocation rate. 1,2,10,13,19 However, because of the structural complexities of this disorder, unfavorable clinical outcomes after MPFL-R have also been reported recently. 23 It has been reported that isolated MPFL-R does not considerably improve patellar tracking or restore patellofemoral kinematics.…”