I'd like to acknowledge the program committee for the opportunity to present. We have no relevant disclosures to this presentation. As we've heard today, patellar dislocation is a common injury among young athletes, particularly females. And for most of these patients, non-operative management remains a standard of care. However, in certain high-risk individuals, this can result in elevated rates of recurrent instability with subsequent MPFL disruption, in addition to other concomitant knee injuries. As has been indicated, multiple surgical techniques have been described to either repair or reconstruct the MPFL in order to restore its function as a soft tissue restraint. And currently, as we've heard in the literature and the studies today, MPFL reconstruction is favored due to the favorable outcomes with superior functional outcomes and also lower rates of failure. However, there remains limited data comparing these two techniques with follow-up that extends past eight years. And so the purpose of our investigation was to compare the long-term clinical outcomes, complications, and failure rates of performing isolated MPFL repair or isolated MPFL reconstruction in the setting of recurrent lateral patellar instability. So this is a retrospective single institution investigation where we identified all patients with a primary MPFL repair reconstruction over the course of seven years. We included those with two or more episodes of patellar instability, a minimum of eight years of follow-up. We excluded those with revision surgeries or prior or concomitant tibiotubercle osteotomies or trochleoblasties. Our final cohort consisted of 29 knees with MPFL repairs and also 29 knees with MPFL reconstructions at a mean follow-up of around 12 years. Looking at their demographics, there's no differences between age, sex, number of dislocations, records participation, or pre-op TT and TG between the repair and reconstructive group. However, the MPFL reconstruction group was younger at the time of initial injury. They had higher rates of generalized laxity and also a longer interval between the injury and surgery in addition to a shorter follow-up of nine years compared to 14 years with the repair group. Clinical outcomes, there's no differences with post-operative outcome scores which consisted of the Tegner score, Lissom score, Krujawa score, return to play rates, complications or re-operations. However, with respect to failure, which we defined as a repeat lateral patellar dislocation at any time after surgery, MPFL repair had a 41% failure rate while MPFL reconstruction had a 14% failure rate. We performed a multivariate analysis looking at some of these risk factors where we demonstrated that MPFL reconstruction had a lower odds of failure whereas increasing age at the time of surgery demonstrated an increased odds of failure. Some limitations are the retrospective non-randomized nature of our investigation which allowed for a selection bias, a relatively small sample size which may limit the ability to adequately power our analysis, and these patients were treated by multiple surgeons over a seven-year span which resulted in multiple techniques and some variations in the rehab protocols. In summary, at long-term follow-up, MPFL repair led to a higher failure rate at 41% when compared to MPFL reconstruction at 14%. Outside of failure, MPFL repair and reconstruction had relatively similar clinical outcomes, return to play rates, overall complications and re-operations. And surgical technique, namely MPFL reconstruction and older age at the time of surgery may be associated with a lower odds of subsequent failure. Thanks.

patellar dislocation

non-operative management

recurrent instability

MPFL reconstruction

failure rate