MPFL in First-Time Dislocators

Stein, Beth E. Shubin; Gruber, Simone; Brady, Jacqueline M.

doi:10.1007/s12178-018-9473-4

Cited by 20 publications

(14 citation statements)

References 34 publications

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“…Patellar dislocation is a common injury in young athletes, primarily women, with the majority of instances occurring secondary to sports-related trauma. 22,38 In addition to age and sex, a history of contralateral patellar instability or family history of patellar instability can increase a patient’s risk for dislocation. 38 Rates of patellar dislocation have been reported to be between 5.8 and 77.8 per 100,000.…”

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confidence: 99%

“…22,38 In addition to age and sex, a history of contralateral patellar instability or family history of patellar instability can increase a patient’s risk for dislocation. 38 Rates of patellar dislocation have been reported to be between 5.8 and 77.8 per 100,000. 17,28,39 Despite nonoperative management resulting in high rates of recurrent instability (15%-50%) and evidence showing that MPFL instability causes levels of knee dysfunction similar to those of anterior cruciate ligament ruptures, patients still wait up to 5 times as long to seek surgical management.…”

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confidence: 99%

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

et al. 2020

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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.

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confidence: 99%

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confidence: 99%

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

et al. 2020

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“…In kind, surgical treatment has made significant advances in the last two decades and now includes high success rates with soft-tissue realignment procedures used in skeletally immature patients, such as MPFL reconstruction. 29 - 32 There are also multiple bony realignment procedures, including but not limited to tibial tubercle transfers, used for correction of anatomical bony defects that predispose to patellofemoral injury. 3 , 33 , 34 A recent systematic review in 2015 examined 11 studies, pooling the results of 470 conservatively managed and 157 operatively managed knees, and found surgical treatment of first-time patella dislocation in children and adolescents was associated with a lower risk of recurrent dislocation and higher health-related quality of life and sporting function.…”

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confidence: 99%

Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients

McFarlane

Coene

Feldman

et al. 2021

Journal of Children's Orthopaedics

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Purpose Patellofemoral instability is a common cause of knee pain and dysfunction in paediatric and adolescent patients. The purpose of the study was to evaluate the frequency of patellar dislocations seen in emergency departments (EDs) and the rates of surgical procedures for patellar instability at paediatric hospitals in the United States between 2004 and 2014. Methods The Pediatric Health Information System database was queried for all paediatric patients who underwent surgery for patellar instability or were seen in the ED for acute patellar dislocation between 2004 and 2014. This was compared with the annual numbers of overall orthopaedic surgical procedures. Results Between 2004 and 2014, there were 3481 patellar instability procedures and 447 285 overall orthopaedic surgical procedures performed at the included institutions, suggesting a rate of 7.8 per 1000 orthopaedic surgeries. An additional 5244 patellar dislocations treated in EDs were identified. Between 2004 and 2014, the number of patellar instability procedures increased 2.1-fold (95% confidence interval (CI) 1.4 to 3.0), while orthopaedic surgical procedures increased 1.7-fold (95% CI 1.3 to 2.0), suggesting a 1.2-fold relative increase in patellar instability procedures, compared with total paediatric orthopaedic surgeries. Conclusion This study shows a significant rise in the rate of acute patellar instability treatment events in paediatric and adolescent patients across the country. Surgery for patellar instability also increased over the study period, though only slightly more than the rate of all paediatric orthopaedic surgical procedures. This may suggest that increasing youth sports participation may be leading to a spectrum of increasing injuries and associated surgeries in children. Level of Evidence IV

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“… 2 , 9 Young athletes and high-risk patients may benefit from surgery after a single patellar dislocation. 10 , 11 , 12 …”

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confidence: 99%

“…Recurrent instability may occur in 17% to 40% of patients who have been treated nonoperatively for first-time dislocations 2, 9. Young athletes and high-risk patients may benefit from surgery after a single patellar dislocation 10, 11, 12Table 1Indications for MPFL ReconstructionRecurrent (≥2) patellar dislocationsSymptoms of ongoing patellar instabilityExcessive lateral patellar laxity on physical examinationFailure to improve with nonoperative managementConcurrent osteochondral injuryAcute MPFL bony avulsionMPFL, medial patellofemoral ligament.…”

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confidence: 99%

Double-Bundle Medial Patellofemoral Ligament Reconstruction With Allograft

Rosinski¹,

Chakrabarti²,

Gwosdz³

et al. 2019

Arthroscopy Techniques

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Medial patellofemoral ligament (MPFL) reconstruction is the treatment of choice for recurrent patellofemoral instability. Although attention to MPFL reconstruction in the orthopaedic literature has increased dramatically in recent years, there is no clear consensus on surgical technique, graft option, or method of fixation. Nevertheless, most studies have shown improved pain scores and low rates of recurrent dislocation in patients after surgery. Despite the early success of MPFL reconstruction, complications may occur more frequently than previously appreciated and include patellar fracture, postoperative instability, and loss of flexion. This article describes our technique for double-bundle MPFL reconstruction with an allograft while highlighting certain aspects of the procedure that are critical for achieving favorable outcomes. The main advantages of the technique include strong patellar fixation with suture anchors and anatomic graft placement at the origin and insertion of the native MPFL. In our experience, this method of reconstruction has been safe, reproducible, and effective in the treatment of patients with patellar instability.

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MPFL in First-Time Dislocators

Cited by 20 publications

References 34 publications

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

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

Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients

Double-Bundle Medial Patellofemoral Ligament Reconstruction With Allograft

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