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Age at time of Surgery but not Sex related to Outcomes after Isolated MPFL Reconstruction
ESSKA Academy. Hiemstra L. May 11, 2018; 218046
Dr. Laurie Hiemstra
Dr. Laurie Hiemstra
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Abstract
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Objectives: Multiple studies have shown that children and adolescents are at increased risk of patellofemoral instability compared to adults, as well as being at increased risk of recurrence after a first-time dislocation. Sex has also been proposed to have an influence on patellofemoral instability. The purpose of this study was to investigate the influence of age at the time of surgery and sex on patient-reported quality of life and clinical outcome following isolated medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellofemoral instability.

Methods: Demographic and clinical data was collected pre-operatively including age at first dislocation, sex, the presence of knee hyperextension greater than 10°, the presence and grade of trochlear dysplasia, and the WARPS/STAID classification. Patients were assessed clinically at the 12- and 24-month follow-up appointments, and any reports of re-dislocation or instability were also noted. Patients completed the Banff Patellofemoral Instability Instrument (BPII) pre-operatively and at the post-operative follow-up visits, to assess disease-specific quality of life. To assess the effects of age at surgery and sex on BPII, multiple linear regression models were fit predicting BPII at 12- and 24-months.

Results: Complete data and minimum 12-month BPII scores were available for analysis for 298/328 patients (90.9%). Average duration of follow-up was 26.4 months. There were eleven failures in the cohort (3.4%). The pre-operative unadjusted regression model did not indicate a significant (alpha=0.05) difference in BPII scores when compared using age at time of surgery or sex. For the 12- and 24-month BPII scores, the model indicated no significant effect of sex. Age at the time of surgery was statistically significant for each post-operative time point, with lower BPII scores apparent for each 10-year increase in age at time of surgery. In the adjusted regression model, the WARPS/STAID score was significantly associated with the pre-operative BPII score. For the 24-month post-operative BPII scores, age at time of surgery and the pre-operative WARPS/STAID score were both significant. Lower BPII scores were apparent for each 10-year increase in age at time of surgery, as well as for lower scores on the WARPS/STAID classification.

Conclusions: This study demonstrated that patient age at the time of surgery had a significant effect on patient-reported outcomes, with lower BPII scores apparent for each 10-year increase in age at time of MPFL reconstruction. These findings suggest that delaying stabilization surgery in symptomatic patients may lead to poorer outcomes. There was no difference demonstrated in outcomes for males versus females at 12- or 24-months post-operative. Patients who presented with a lower WARPS/STAID classification score demonstrated lower pre- and post-operative quality-of-life outcome scores.

Keywords:
medial patellofemoral ligament (MPFL), MPFL reconstruction, age, sex, quality of life, Banff Patella Instability Score (BPII), WARPS/STAID classification
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