Study Finds Ligament Reconstruction is an Effective Treatment for Kneecap Instability in Patients with Trochlear Dysplasia

HSS study shows success even in patients with more complicated cases

San Diego, CA—March 16, 2017

While a first time kneecap dislocation can usually be treated non-surgically, recurring dislocations often necessitate surgical intervention. MPFL (medial patellofemoral ligament) reconstructions have become a common surgical option and have seen improved outcomes and a high rate of return to sport.

However, it was previously unknown if this procedure is effective for people with trochlear dysplasia. Those who have recurrent patellofemoral -- or kneecap -- instability have a high incidence of trochlear dysplasia, the most common bony problem.

A new study from Hospital for Special Surgery (HSS) that was shared today at this year’s annual meeting for The American Academy of Orthopaedic Surgeons (AAOS) looks to determine if isolated MPFL reconstructions work for patients with trochlear dysplasia, sparing these patients larger more complicated bony procedures. It was a retrospective review of 105 patients who underwent MPFL reconstructions with Beth E. Shubin Stein, MD, sports medicine surgeon at HSS, with a 10 year follow up.

The study found high patient outcomes scores (87.2 on the Kujala Anterior Knee Pain Scale) and a high return to sports at one year (89 percent of those who participated in sports preoperatively). There was a 97 percent success rate; only 3 patients reported a postoperative dislocation.

"As surgeons, we like to do the least invasive surgery possible to fully fix the problem," said Dr. Shubin Stein, lead investigator. "With this study, we found that  MPFL reconstruction is a safe and effective treatment for patients with patellofemoral instability even if in patients that have trochlear dysplasia."

In addition to MPFL reconstructions (a soft tissue procedure), surgeons can also perform a tibial tubercle osteotomy or trochleaplasty (both bony procedures) to regain stability in a patellar dislocation.

Both soft tissues and bony constraints maintain patellofemoral stability together. As such, surgeons in the past were sometimes reluctant to only perform a soft tissue procedure since it doesn’t address the bony pathology that may also contribute to the instability.

"Equally as important, we showed that this technique can be done in patients who might previously be advised to undergo a bony procedure such as tibial tubercle osteotomy or trochleoplasty, which can be high risk surgeries," added Dr. Shubin Stein.

Additional HSS authors include: Joseph N. Liu, MD; Irene L. Kalbian, BA; Sabrina M. Strickland, MD; and Joseph T. Nguyen, MPH.

 

About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics for 14 years in a row and No. 2 in rheumatology by U.S.News & World Report (2023-2024). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In addition, HSS opened a new facility in Florida in early 2020. In 2019, HSS provided care to 151,000 patients and performed more than 35,000 surgical procedures, and people from all 50 U.S. states and 89 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 translational research laboratories, 33 scientists, 10 clinician-scientists, 55 clinical investigators and 245 scientific support staff that drive the HSS research enterprise in the musculoskeletal “ecosystem,” neurology, pain management and rheumatic diseases. The HSS Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is the world’s leading provider of education on musculoskeletal health, with its online learning platform offering more than 300 courses to more than 30,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.

 

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