Today’s article “Medial Patellofemoral Ligament Reconstruction for Adolescents With Acute First-Time Patellar Dislocation With an Associated Loose Body” from Gurusamy et al. is from Rady Children’s Hospital in San Diego.
Patella (kneecap) instability is a very interesting topic. Nonoperative care is the mainstay of treatment for first time patella dislocations in patients without another indication for surgery. The authors in this study looked at a population of first-time dislocations that did have an indication for surgery- a loose body. Their cohort of patients were all younger than 19.
In one arm of the study the authors either repaired the medial patellofemoral ligament (MPFL) or did not treat it at all. In the treatment cohort they reconstructed the MPFL using an allograft tendon fixated to the femur and tibia.
The results showed a lower recurrent rate and need for additional surgery in the MPFL reconstruction group compared to the repair/no treatment group. They also showed a higher return to sport at 66.7% in the reconstruction group compared to 39% in the repair/no treatment group. Although the patient reported outcome measures were not significantly different between the two groups, the authors report that data was not collected from 21 of the patients in the no treatment/repair group that required a second surgery for stabilization.
This was a very interesting article and adds evidence for the addition of a reconstruction procedure if addressing a loose body in a first-time patella dislocation.