Results of medial patella stabilization surgery at 11-14 years, with realignment surgery according to an algorithmic approach

OBJECTIVES: To report long term outcomes of patella stabilization surgery, and describe an algorithmic approach to realignment and other ancillary surgery METHODS: RETROSPECTIVE OBSERVATIONAL SERIES: All 49 consecutive cases of medial retinacular plication, usually with Medial Patello-Femoral Ligament (MPFL) reconstruction using a redundant local graft, for patella instability, by a single surgeon from 2001 to 2005 were sent a questionnaire, and followed up by phone. Realignment and other surgery was included as indicated by the senior author’s algorithmic criteria. Nine patients were not contactable, and four chose not to participate, leaving 29 patients with 35 operated knees who are the subject of this study. RESULTS: Tegner-Lysholm scores were 77% excellent or good (mean 90 +/− 10, 61-100). Kujala scores were: mean 90 +/− 13, 34-100. The re-dislocation rate was 11% (4 knees, 2 of 9 after plication without MPFL reconstruction). Five knees had further surgery (3 revisions, 1 loose body, 1 arthrofibrosis). The worst results were in those who first came to surgery before skeletal maturity, with 6 of those 10 having fair or poor final outcomes. Only two others had fair or poor results. CONCLUSION: Chondral damage at a young age was the key factor contributing to poor results. At minimum 11 year follow-up, the re-dislocation rate after MPFL reconstruction, (plus re-alignment as indicated), was 2 of 26 (8%). A redundant local graft, with zero donor site morbidity, is adequate for reconstruction of the MPFL, which is more reliable than plication alone, even when the MPFL is felt to have a sound femoral attachment.