Management and Outcomes of an Acute Mid Substance Medial Patella Femoral Ligament Repairs in Adolescents

Abstract

Background: Traumatic patellar dislocation with mid substance medial patellofemoral ligament (MPFL) tear is addressed with a MPFL repair. There is no definitive protocol detailing postoperative management of MPFL repairs. Using an open MPFL repair followed by physical therapy, we created a standardized protocol to optimize outcomes and return patients to previous levels of activity. Methods: We retrospectively reviewed the charts of 23 patient athletes, aged 11 to 18 years (mean, 15.2 years), who experienced a traumatic patellar dislocation with subsequent MPFL injury and intra-articular pathology who were treated according to our protocol between 2006 and 2009. We analyzed the clinical results of this cohort at each of their follow-ups with interval radiographic imaging. Patients were evaluated based on time until return to play and recurrence of patellar dislocation or instability. On final assessment, patients completed the Kujala knee score. Results: Mean time to return to play was 7 months. Of the patients who underwent surgical intervention and our perioperative rehabilitation protocol, three had recurrent dislocations. Patients with clinical and radiographic documentation of recovery achieved nearly 100% of their baseline function and reported that they were able to function at pre injury levels. 8 patients completed the Kujala knee score (average score, 96.3). Recovery times and return to play did not vary based on mechanism of injury, sex, or sport activity. Conclusion: Acceptable results can be obtained following traumatic patellar dislocation and subsequent surgical mid substance MPFL repair in adolescents using a defined surgical and rehabilitative algorithm.