Thank you, thanks to Anna for the opportunity to present our work and to my co-authors. Our disclosures are listed on the website. So as background, patellar instability is primarily an injury in young and active patients, incidence of 23 per 100,000, with a higher recurrence rate amongst female participants. Recurrence rates anywhere from 15 to upwards of 40, 50% with non-operative treatment, however following a recurrence we know that a further recurrence will take place in upwards or greater than 50% of this population. And surgical treatment is typically recommended following a recurrent dislocation, however there's still no consensus on optimal technique. Currently there's a paucity of literature regarding return to sport and return to pre-injury and pre-operative levels of activity following MPFL reconstruction. And this knowledge gap exists regarding pre-operative counseling of the post-operative state that these patients can experience. So our study purpose is that in patients undergoing a primary MPFL reconstruction we wanted to determine our patient's rate of return to sport, their activity levels thereafter, and the reasons that they did not resume their pre-operative activity levels if they did not. This was a retrospective chart review over almost a 10 year period of time with a consistent technique. This image is taken from Beth Schubenstein, though this was the similar technique used for all of these patients with a cortical-based technique on the patella and a two-tailed docking interference fit on the femoral side. They had a concomitant tibiotubercle osteotomy if their TTTG was greater than 20. This represented three surgeons all sports medicine fellowship trained with a minimum of one year follow-up and each patient was contacted and a survey administered. We collected demographics, any concomitant procedures, what the graft type and graft processing was, as well as pre- and post-operative SF12, Norwich patellar instability score, and tegener activity level. In the 44 knees that we examined, 71% of the patients were female with an average age of 23 plus or minus seven years, an average follow-up of just over three years in our population with almost 30% having a concomitant tibiotubercle osteotomy. Improvements across the board were demonstrated in the Norwich patellar instability index as well as both SF12 scores. We had no recurrence of dislocation in the entirety of the cohort. Two had a subjective sensation of subluxation. One required a revision MPFL reefing and eight had a subsequent procedure. Four for hardware removal, one had a dreaded patellar fracture, one had an arthroscopy and one crest bone graft for a TTO non-union, and one went on to progressive DJD that required an arthroplasty. As far as the activity levels, we showed that the tegeners increased from a pre-operative state of nearly two to almost six post-operatively, however, and what is probably the most significant finding of this paper is that the post-operative tegener was lower than the pre-injury tegener. And this is the first data set that I'm aware of that shows this curve of where our patients that start pre-injury go significantly decrease their activity pre-operatively, though post-injury, and then where they get back to on average post-operatively. Overall 72% of the cohort returned to at least a sport, so a tegener of five or higher, whereas only 40% were able to return to their pre-injury level of sport, and those patients had a pre-operative significant higher initial tegener compared to those that were not able to return. While nearly half or greater than half changed their primary sport or activity post-operatively. Their reasons for not returning to their previous sport in 77% of these patients was nothing to do with their knee function or stability, either lack of interest, fear of re-injury or moving on with other life factors, say graduating from high school or college or moving on to a different stage of life. And we showed that for every year increase in age that the mean tegener improvement decreased by nearly 2.2 per year of age increase. Of the 30% of knees that had a tibial tubercle osteotomy, they had a significantly worse post-operative tegener compared to those that did not, and no associations were found with any graft, be it auto or allograft or graft processing type. So following MPFL reconstruction, we can expect that about 70% of our patients are going to return to sport, however, less than half will return to their pre-injury levels, and the patients at risk seem to be slightly older patients in this population and those that are undergoing a concomitant tibial tubercle osteotomy. We found that in our study MPFL outcomes were not influenced by graft type or processing method and that many did not return to sport due to fear rather than knee dysfunction and other life factors seem to be more important rather than the stability of their knee post-MPFL reconstruction. Thank you.

MPFL reconstruction surgery

return to sport

activity levels

patients

study