Does Patient Age Matter for Medial Patellofemoral Ligament Reconstruction? Patients ≥30 Years of Age Compared With Younger Patients.

Abstract

Background: Medial patellofemoral ligament (MPFL) reconstruction is a common procedure to treat recurrent patellar instability. Outcomes in older patients after this procedure have been less frequently reported in the literature.

Hypothesis: Patients ≥30 years of age would demonstrate similar subsequent dislocation risk and patient-reported outcomes (PROs) after MPFL reconstruction to younger patients.

Study design: Cohort study; Level of evidence, 3.

Methods: A retrospective review was undertaken to identify patients who underwent isolated MPFL reconstruction between 2008 and 2020. Patients were categorized into 2 groups based on age ≥30 years or <30 years at the time of surgery. Subsequent patellar dislocation risk and PROs (Knee injury and Osteoarthritis Outcome Score [KOOS], Norwich score, and Marx activity score) were compared between groups. PROs were compared controlling for anatomic and other demographic differences between groups.

Results: A total of 228 patients underwent isolated MPFL reconstruction in the study period; 177 patients (78%) were assessed for subsequent patellar dislocation a minimum of 1 year postoperatively (median, 3.4 years). The study included 140 patients <30 years of age at surgery and 37 patients ≥30 years of age at surgery. Subsequent dislocation occurred in 9 patients (5.1%), including 7 patients <30 years (5.0% subsequent dislocation risk) and 2 patients ≥30 years (5.4% subsequent dislocation risk; P > .99). In total, 147 patients completed PRO score surveys at a median of 3.8 years postoperatively. Patients ≥30 years at surgery (n = 31) had poorer KOOS pain (82.1 vs 91.7; P = .03), KOOS activities of daily living (94.1 vs 97.1; P = .04), and Marx activity score (1 vs 7; P < .001) compared with the patients <30 years (n = 116). After adjusting for anatomic and demographic factors, KOOS pain subscale values were significantly poorer for patients ≥30 years (β = -4.3; 95% CI, -8.3 to -0.2; P = .04). No differences in Norwich score or other KOOS subscale values were noted.

Conclusion: Patients ≥30 years at the time of MPFL reconstruction demonstrate similar subsequent dislocation risk but poorer KOOS pain subscale and Marx activity values than patients <30 years at the time of MPFL reconstruction.