Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Brace in Children With an Acute First-Time Traumatic Patellar Dislocation: A Randomized Controlled Trial

Abstract

Operative repair of an MPFL injury in the acute phase in skeletally immature children with a primary traumatic LPD significantly reduced the redislocation rate but did not improve subjective or objective knee function compared with a knee brace without repair. The majority of the patients in both groups were satisfied with their knee function. There was a high representation of APIFs, which needs to be considered when evaluating the risk of redislocations. Registration: ISRCTN 39959729 (Current Controlled Trials).

Editorial Commentary: Medial Patellofemoral Ligament Repair Versus Reconstruction: Still a Question or a Clear Winner?

“…In addition, the Kujala score was not assessed in 3 of 8 patients with failure who underwent additional surgery, severely limiting conclusions that could be drawn from this small group. Askenberger et al 12 showed minimal difference in Kujala scores between operatively and nonoperatively treated patients despite significant differences in redislocation rates. Finally, the study by Puzzitiello et al 1 suggests that we may want to be more aggressive in the treatment of patellar instability in patients with patella alta.…”

Does surgical treatment produce better outcomes than conservative treatment for acute primary patellar dislocations? A meta-analysis of 10 randomized controlled trials

“…In total, the literature search identified 355 potentially relevant papers. Ten RCTs [6,[20][21][22][23][24][25][26][27][28] met the inclusion criteria after removing duplicates, scanning the titles and abstracts, and reviewing the full texts. Among all the participants in the 10 RCTs, 297 patients were treated with a surgical procedure, while 263 were treated with conservative therapy.…”

“…Nikku et al [20] and Palmu et al [22] also noted that primary repairing the injured medical retinacular structures might not improve knee function outcome in the long run. Muscle function can be another reason [28]. The most common complication following knee surgery is reduced range of motion, with accompanying pain over the medial retinaculum or in the patellofemoral joint in up to 30% of cases [31].…”

“…Firstly, all the included studies showed some weaknesses, mainly related to low-quality RCT design regarding factors such as age, gender, surgical, and rehabilitative interventions. Three studies [22,26,28] reported solely on patients younger than 16 years, one study [27] contained no information on patient age, and the remaining six studies included patients of varying ages, including children, adolescents, and adults; this may have affected the outcomes, as age is reportedly correlated with the incidence of primary and recurrent patellar dislocation [36]. Secondly, the risk of bias scores reflects that some studies are at high risk, although all data were extracted from RCTs.…”

Editorial Commentary: What Is the Optimal Management of First and Recurrent Patellar Instability? Patellofemoral Instability Management Continues to Evolve

“…Camp et al 12 evaluated repairs and concluded that it is "a viable surgical option if surgical technique principles are followed." A 2018 study by Askenberger et al 13 found that "operative repair of an MPFL injury in the acute phase in skeletally immature children with a primary traumatic LPD [lateral patellar dislocation] significantly reduced the redislocation rate," with trochlear dysplasia being the highest risk factor for recurrent dislocation. The concept of an odds ratio for a second dislocation reminds us of the importance for studies to define their population.…”