Thank you for the introduction. On behalf of my co-authors, we have no disclosures pertinent to this talk, and full disclosure information is available on the AAOS website. As we've just heard, non-operative treatment after initial patellar dislocation carries approximately 40% recurrent instability rate. As such, and especially given the high demand for lower extremity mechanics placed on our active duty soldiers, primary MPFL reconstruction is a widely used surgical technique with a reported high rate of return to pre-injury activity level. However, there is limited data to follow to guide counseling our high impact and elite athletes about returning to their sport, and currently there is no data regarding military-specific return to duty following MPFL reconstruction. The purpose of our study was to determine if service members were able to return to full duty after surgical reconstruction, and to identify factors affecting their prognosis. A retrospective review was performed to identify active duty service members undergoing primary MPFL reconstruction throughout the Department of Defense health system between 2012 and 2015. We utilized the Management Analysis and Reporting Tool, M2 database, to perform a query of CPT codes associated with MPFL surgery. Patients were included if they were on active duty status at the time they underwent primary MPFL reconstruction. We excluded patients if they were undergoing a procedure other than primary MPFL reconstruction, if they were not on active duty status at the time of their index procedure, or if they'd already started undergoing the medical separation process, which is dubbed MEB, or patients with insufficient follow-up, which we set at a minimum of two years. Cardiac and surgical variables were recorded, as well as the ability to return to impact activities and to remain on active duty status. The rates of recurrent instability and the need for subsequent surgeries were identified. Of the 636 patients who underwent surgery for patellar dislocation during the study period, 103 patients met inclusion criteria with a mean age of 27 and a mean of four years of follow-up. In reviewing operative notes, cartilage damage was present in about 36 percent of patients at the time of their index surgery, and 54 percent of those patients underwent a concomitant cartilage procedure at the time of primary MPFL reconstruction. A concomitant TTO was performed in 11 patients. A total of 20 patients developed recurrent instability, which was significantly higher in patients that had bilateral patellar instability. Revision surgery to address recurrence occurred at a rate of 2.9 percent, consistent with previously reported recurrence data. Unrestricted activity restrictions were significantly more common in patients with recurrent instability. Patient age and gender had no effect on return to sporting activity or military retention. Only 49.5 percent of military service members undergoing primary MPFL reconstruction were able to return to unrestricted impact activity after surgery, and 26 percent ultimately underwent medical separation from the military. Recurrent or bilateral instability negatively affected the return to impact activities. And most importantly, while only 14 percent of our study population had osteoarthritis on presentation, these service members had more than double the risk of being on a limited duty profile or being referred for medical separation after undergoing their procedure. That being said, the limitations of our study are not insignificant. Our analysis utilizes a retrospective data with inherent bias associated with this design. There are also numerous CPT codes associated with patellar instability surgery, but none is specific to MPFL reconstruction. Furthermore, we utilized a worldwide database, which allows us to access immense data, but it brings the challenge of including dozens of surgeons with the possibility of varied surgical techniques. And finally, there's inconsistent documentation within the limited duty profile system and the medical separation process, which makes it difficult to determine the exact nature of their necessity. So the next phase of our project involves subgroup analysis to assess military-specific factors that may contribute to successful retention, such as rank, military occupational specialty, or biometric data. And our present study demonstrates that further solutions need to be developed to be able to treat these patients in ways that allow them to return to their previously high levels of physical activity and to remain unrestricted active duty status. Thank you.

active duty service members

MPFL reconstruction surgery

return to duty

military retention

surgical techniques