Reconstruction of the Medial Patellofemoral Ligament: Clinical Outcomes and Return to Sports.
BACKGROUND
Recent studies have shown that medial patellofemoral ligament (MPFL) reconstruction using a standardized technique provides significant improvements in all outcome scoring systems, with low complication rates and good patient satisfaction. Although numerous studies have assessed clinical results, there is little published literature investigating return to sporting activities after reconstruction of the MPFL.


OBJECTIVE
To demonstrate postoperative outcomes and the return-to-sports rate a minimum of 2 years after isolated MPFL reconstruction in a young patient cohort.


METHODS
Case series; Level of evidence, 4.


METHODS
Between 2007 and 2010, a total of 72 isolated MPFL reconstructions (in 68 patients) were performed for recurrent patellar dislocation. Pre- and postoperative knee assessment included a thorough history of symptoms and a clinical examination consisting of crepitus, range of motion, patellofemoral pain, and patellar apprehension. Knee function was assessed using the Kujala score, International Knee Documentation Committee score, Tegner activity score, visual analog scale (VAS), and Activity Rating Scale (ARS).


RESULTS
Of patients who participated in sports preoperatively (62/68 patients), 100% returned to sports after MPFL reconstruction; 53% returned at equal or higher levels, whereas 47% returned at lower levels. Fifty-four of 68 patients (79.4%) rated themselves as very satisfied or satisfied with the results. The median Kujala score improved significantly from 66 to 87.5 and the median International Knee Documentation Committee score from 60 to 79.8. The median VAS for pain score illustrated significant preoperative to postoperative improvement, from 4 to 2. Conversely, patients' activity levels according to the Tegner activity score dropped from 4.5 to 4, and the median Activity Rating Scale score dropped from 6 to 3. There was also a persistent instability rate of 10% as well as a slight loss of knee flexion in 24 of 72 knees.


CONCLUSIONS
Reconstruction of the MPFL is a safe and effective treatment for patellofemoral instability without severe trochlear dysplasia and allows most patients to engage in regular sports activities 2 years postoperatively, at least at a recreational level. However, potential complications, such as persistent instability, pain, and loss of flexion, must be considered.
Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany sabinelippacher@yahoo.de.
Sabine
S
Lippacher
Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
Jens
J
Dreyhaupt
Clinics Kempten/Oberallgäu, MVZ Oberstdorf and Teaching Hospital of the University of Ulm, Ulm, Germany.
Sean R M
SR
Williams
Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany.
Heiko
H
Reichel
Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany.
Manfred
M
Nelitz
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D010329:Patella / Q000601:surgery*; D031222:Patellar Dislocation / Q000601:surgery*; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D020127:Recovery of Function; D000068958:Return to Sport; D016896:Treatment Outcome
MPFL; patellofemoral instability; return to sports