Recurrence Rates of Patellofemoral Instability Post-MPFL Reconstruction in Youth

Overview

This systematic review and meta-analysis evaluated recurrent patellofemoral instability rates following MPFL reconstruction and other soft tissue realignment techniques in skeletally immature patients. Findings indicate that recurrence rates after MPFL reconstruction are comparable to those observed with alternative soft tissue procedures.

Background

Patellofemoral dislocation is a frequent knee injury in children and adolescents, with the highest incidence in ages 14 to 18 years. The risk of recurrent instability after primary dislocation varies widely, and the pathomechanism is multifactorial involving osseous and ligamentous factors. While conservative treatment is preferred after first dislocation, surgery is indicated for recurrent cases. In skeletally immature patients, soft tissue realignment techniques, including MPFL reconstruction, are favored over bony procedures to avoid growth plate damage.

Data Highlights

The systematic review included studies on skeletally immature patients undergoing MPFL reconstruction or other soft tissue realignment techniques. Recurrence rates of patellofemoral instability after these procedures varied but showed no significant differences between MPFL reconstruction and other methods. The review adhered to PRISMA guidelines and included data from multiple databases up to May 2019.

Key Findings

• Patellofemoral instability recurrence rates after MPFL reconstruction are similar to those after other soft tissue realignment surgeries in skeletally immature patients.
• Soft tissue procedures remain the preferred surgical option in children and adolescents due to the risk of growth plate injury with bony surgeries.
• MPFL reconstruction techniques have evolved with various grafts and fixation methods showing promising outcomes.
• The multifactorial nature of patellofemoral instability necessitates individualized treatment planning.
• Current evidence does not demonstrate superiority of any single soft tissue realignment technique over others regarding recurrence rates.

Clinical Implications

Clinicians can consider MPFL reconstruction as an effective surgical option for recurrent patellofemoral instability in skeletally immature patients, with recurrence rates comparable to other soft tissue procedures. Decision-making should weigh the risks of growth plate damage associated with bony procedures and the multifactorial etiology of instability. Patients and families should be counseled on the similar efficacy and potential risks of available soft tissue techniques.

Conclusion

MPFL reconstruction offers recurrence rates comparable to other soft tissue realignment methods in skeletally immature patients with patellofemoral instability. This supports its use as a viable surgical option in this population.

References

1. Nelitz et al. 2019 -- Trochleoplasty in Adolescents with Trochlear Dysplasia
2. Systematic Review Protocol PROSPERO CRD42017069706