Comparison of outcomes after MPFL reconstruction in adult vs pediatric populations: A systematic review of the literature

Abstract

Purpose The purpose of this study is to compare the outcomes of medial patellofemoral ligament (MPFL) reconstruction in pediatric and adult populations. We hypothesize that pediatric patients will have poorer outcomes compared to adults. Methods PubMed, CINAHL, and EMBASE were queried using search terms relevant to MPFL reconstruction in pediatric and adult populations. Results were screened by title, abstract, and full text by two independent reviewers to determine inclusion eligibility. Articles with a total sample size \u3e30 and a minimum follow-up of \u3e2 years that reported on individuals \u3c 18 or \u3e18 years of age with recurrent patellar dislocations treated with isolated MPFL reconstruction were eligible for inclusion. Data on patient-reported outcome scores, recurrent instability rates, and complications were extracted for analysis. Results Eight studies met inclusion criteria and yielded data on 282 MPFL reconstructions. The average age of patients was 14.9 years for pediatric studies and 25.4 years for adults. The average follow-up was 49.04 months. No adults experienced additional dislocation events post-operatively, while 8/90 (8.9 %) of pediatric patients reported recurrent instability. Post-operative Lysholm scores were similar between populations (90.8 in adult, 89.8 in pediatric). Pediatric postoperative Kujala scores were 7.5 % lower than adult postoperative scores, reflecting greater pain and disability (91.2 in adult, 84.4 in pediatric). Two pediatric studies reported stiffness in 10/55 (18.2 %) of patients, while all adult studies reported full restoration of motion. Conclusion MPFL reconstruction results in good outcomes in both pediatric and adult populations with patellar instability. Recurrent instability, stiffness, lower return to sport, and worse patient-reported outcomes were more prevalent in pediatric populations. Future studies should account for this discrepancy and consider studying these groups separately or performing subgroup analyses to better understand outcomes