2021 ISAKOS Biennial Congress ePoster
Isolated Lateral Release For Chronic Patella Instability: Increased 5 Year Revision Rate As Compared To A Cohort Undergoing Medial Patellofemoral Reconstruction
Adam Money, MD, Redwood City, CA UNITED STATES
Seth L. Sherman, MD, Redwood City, California UNITED STATES
Kunal Varshneya, BS, Redwood City, CA UNITED STATES
Andrew Gudeman, MD, Indianapolis, IN UNITED STATES
Kevin G. Shea, MD, Palo Alto, California UNITED STATES
Stanford University, Redwood City, CA, UNITED STATES
FDA Status Not Applicable
Summary
In a large database comparing patients who underwent isolated LR versus MPFLR for chronic patella instability, the former group had a slightly lower rate of short term complications within 90 days but a 4.5 times higher risk of requiring revision surgery within 5 years
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Abstract
Purpose
Isolated lateral release (LR) has been utilized in patients undergoing surgery for chronic patella instability. As the lateral retinaculum is a secondary restraint to lateral patella translation, there is growing concern that isolated lateral release may further de-stabilize the patellofemoral joint rather than confer joint stability. In recent years, the medial patellofemoral ligament (MPFL) has been shown to be the primary soft-tissue restraint against lateral patellar displacement. Surgery to address MPFL incompetence is the current gold standard for recurrent patellofemoral instability. Our purpose is to evaluate the short-term post-operative complications and long-term revision rates of patients undergoing isolated lateral release (LR) as compared to MPFL reconstruction (MPFLR). Our hypothesis is that short term complication rates are similar but long term revision rates favor MPFLR.
Methods
We queried the MarketScan database in order to identify patients who underwent isolated LR or MPFLR for the surgical treatment of chronic patellar instability from 2007-2015. Data including baseline demographic information, comorbid status, post-operative complications, re-operations, and subsequent procedures were gathered. Risk factors for revision surgery were identified. Results were analyzed statistically.
Results
This study identified 1430 patients (mean age 27.1 years, female 61.4%) who underwent MPFLR and 2168 patients (mean age 33.1 years, female 69.8%) who underwent isolated LR for chronic patellar instability. Patients who underwent MPFLR experienced higher rates of overall complication within 90 days of surgery (11.4% vs 7.3%, p < 0.0001). Through 5 year follow-up, 7.4% of patients who underwent isolated LR required revision surgery as compared to 1.8% of patients who underwent MPFLR as their index surgery (p < 0.0001). After controlling for all baseline covariates between the two cohorts, patients who underwent primary isolated LR were 4.5 times as likely to undergo a revision surgery (95% CI 3.0 – 7.3, p < 0.0001). Female sex (OR 1.5, 95% CI 1.1 – 2.2, p = 0.0194) also increased odds for revision surgery.
Conclusions
In a large database comparing patients who underwent isolated LR versus MPFLR for chronic patella instability, the former group had a slightly lower rate of short term complications within 90 days but a 4.5 times higher risk of requiring revision surgery within 5 years. The rate of revision surgery in the MPFLR group at 5 years was 1.8%. Female sex and increased age also increased the risk of revision surgery overall. This data confirms our hypothesis that medial soft tissue stabilization is superior to isolated lateral release for chronic patella instability to reduce revision rates.