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Author Notes:

Benton E. Heyworth, MD, Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA (email: benton.heyworth@childrens.harvard.edu)

One or more of the authors has declared the following potential conflict of interest or source of funding: M.S.K. has received education payments from Kairos Surgical and royalties from OrthoPediatrics. B.R.W. has received education payments from Smith & Nephew and hospitality payments from Zimmer Biomet. Y.-M.Y. has received consulting fees from Smith & Nephew. D.E.K. has received education payments from Kairos Surgical, consulting fees from Johnson & Johnson and Miach Orthopedics, and financial or material support from Arthrex. L.J.M. has received royalties from SAGE Publishing, Springer, and Wolters Kluwer Health. B.E.H. has received education payments from Arthrex and Kairos Surgical, consulting fees from Arthrex and Imagen Technologies, speaking fees from Arthrex, and royalties from Springer and has stock/stock options in Imagen Technologies. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Subject:

Keywords:

  • patellar instability
  • patellofemoral instability
  • young athletes
  • medial patellofemoral ligament reconstruction
  • tibial tubercle osteotomy

Descriptive Epidemiology of a Surgical Patellofemoral Instability Population of 492 Patients

Tools:

Journal Title:

Orthopaedic Journal of Sports Medicine

Volume:

Volume 10, Number 7

Publisher:

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: Patellofemoral instability (PFI) occurs most commonly in pediatric and adolescent patients, with evolving indications for surgery and changes in surgical techniques over the past decade. Purpose: To characterize the demographic, clinical, and radiologic characteristics of a large cohort of patients undergoing PFI surgery and investigate longitudinal trends in techniques utilized over a 10-year period at a tertiary-care academic center. Study Design: Case series; Level of evidence, 4. Methods: Electronic medical records of patients younger than 25 years of age who underwent primary surgery for lateral PFI from 2008 to 2017 at a single center by 1 of 5 different sports medicine surgeons were retrospectively reviewed. Demographic, clinical, and radiographic parameters of instability were analyzed. Routine surgical techniques included medial retinacular plication/reefing/repair (MRP), medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), or a combination thereof, with or without lateral retinacular release (LR) or lateral retinacular lengthening (LRL). Exclusion criteria, selected for potentially altering routine surgical indications or techniques, included fixed/syndromic PFI, a formally diagnosed collagen disorder, cases in which a chondral/osteochondral shear fragment underwent fixation or was >1 cm in diameter, and body mass index >30 kg/m2. Results: Of the 492 study patients (556 knees; 71% female; median age, 15.2 years; 38% open physes), 88% were athletes, with the most common sports participated in being soccer, basketball, dance, football, gymnastics, and baseball/softball. While 91% of the cohort had recurrent dislocations, the 9% with primary dislocations were more likely to have small osteochondral fractures/loose bodies (P < .001). Female patients were younger (P = .002), with greater patellar tilt (P = .005) than male patients. Utilization of MPFLR and TTO increased significantly over the study period, while use of MRP+LR decreased. Conclusion: Most patients younger than 25 years of age who underwent PFI surgery were skeletally immature, female, and athletes and had recurrent dislocations. The <10% who had primary dislocations and underwent surgery were likely to have osteochondral fractures. Surgical techniques have changed significantly over time, with increasing use of TTO and MPFLR, while the use of MRP+LR/LRL has significantly decreased.

Copyright information:

© The Author(s) 2022

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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