MPFL repair yielded higher failure rates vs. MPFL reconstruction for patellar instability

COLORADO SPRINGS, Colo. — Results presented here showed patients who underwent medial patellofemoral ligament repair for patellar instability had a higher failure rate compared with MPFL reconstruction at long-term follow-up.

Eric Marigi, MD, who presented the study at the American Orthopedic Society for Sports Medicine Annual Meeting on behalf of Bradley Kruckeberg, MD, and colleagues at the Mayo Clinic, noted researchers retrospectively identified patients who underwent either MPFL reconstruction (n=29 knees) or repair (n= 29 knees) for two or more episodes of patellar instability and had a minimum of 8 years of follow-up. Researchers recorded pre and postoperative demographic, surgical, imaging and clinical data for each patient.

The two groups had no differences in age, sex, number of dislocations, sports participation or preoperative tibial tuberosity-trochlear groove distance, according to Marigi.

Eric Marigi

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“However, the MPFL reconstruction group was younger at the time of initial injury hey had higher rates of generalized laxity and also longer intervals between the injury and surgery, in addition to a shorter follow-up 9 years compared to 14 years with the repair group ,” Marigi said.

Although the MPFL reconstruction and repair groups had no differences with postoperative outcome scores, including Tegner score, Lysholm score, Kujala score, return to play rates, complications and reoperations, Marigi said patients in the MPFL repair group had a 41% failure rate vs. a 14% failure rate in the MPFL reconstruction group. Marigi noted failure rate was defined as “repeat patellar dislocation at any time after surgery.”

“We performed a multivariate analysis looking at some of these risk factors where we demonstrated that MPFL reconstruction had a lower odds of failure whereas increasing age at the time of surgery lead to increased odds of failure,” Marigi said.

Perspective

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David R. Diduch, MD

OK, it’s settled then. MPFL reconstruction is simply better than MPFL repair. Bradley Kruckeberg, MD, and colleagues have slammed the door on the idea of ​​MPFL repair with solid, long-term data. This study followed patients for a mean of 12 years and found the failure rate for repair was threefold higher than with reconstruction. These findings reinforce prior publications by Svend E. Christiansen, MD, and colleagues (80 randomized patients, no difference in recurrent instability for nonoperative treatment vs. MPFL repair) and Elizabeth A. Arendt, MD, and colleagues (an unacceptable 46% redislocation rate after MPFL repair).

The answer is clear: Use a graft, reconstruct the MPFL and do not trust a repair or imbrication. Reconstruct the torn anatomy with a gracilis or semitendinosus tendon, both of which are stronger than the native MPFL. Finding the native MPFL can be difficult enough but determining exactly where it is torn is harder. Reconstruction allows the surgeon to precisely and reliably restore stability to the patella—problem solved.

References:

Arendt EA, et al. Knee Surg Sports Traumatol Arthrosis. 2011;doi:10.1007/s00167-011-1516-y.

Christiansen SE, et al. Arthroscopy. 2008; doi:10.1016/j.arthro.2008.03.012.

David R. Diduch, MD

Professor of orthopedic surgery

Division head, sports medicine

Team physician

University of Virginia

Charlottesville, Virginia

Disclosures: Diduch reports no relevant financial disclosures.

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American Orthopedic Society for Sports Medicine Annual Meeting