Background

The medial patellofemoral ligament (MPFL) is the primary soft-tissue restraint against lateral patellar displacement. Surgery to address MPFL incompetence is the current gold standard for recurrent patellofemoral instability. Our purpose is to investigate trends in MPFL reconstruction (MPFLR) using a large national database. Our hypothesis is that MPFL reconstruction is a safe and effective procedures for patients with patellofemoral instability.

Methods

We queried the MarketScan database to order to identify patients who underwent primary MPFLR from 2007-2015. Baseline demographic information and co-morbidities were assessed. Concomitant surgical procedures were recorded. Post-operative complication rates through 90 days following surgery were determined. We evaluated risk factors for re-operation at 90 days and 2 years post-operatively. Day of surgery payments were recorded. Results were analyzed statistically.

Results

19,233 MPFLR were performed from 2007-2015. Mean age was 22.7 + 11.1 years. 11,788 (61.3%) were female. 4,408 patients (22.9%) had co-morbidities including diabetes (2.2%), hyperlipidemia (5.1%), hypertension (6.7%), tobacco use (3.7%), and obesity (5.2%). In regards to concomitant procedures, utilization of a lateral release decreased from 46.2% to 25.5%. Chondroplasty utilization remained constant from 22.9% to 21.8%. Tibial tubercle osteotomy remained constant from 13% to 13.3%. Post-operative complications within 90 days occurred in 2,512 (13.1%) patients. These included dislocation (8.9%), heterotopic ossification (0.4%), stiffness (2.1%), infection (0.6%), wound complication (0.4%), and DVT (0.2%). The rate of complications decreased from 14.7 to 12.7 over the 8 year time period. Obesity was a significant risk factor for re-operation at 90 days (p-value 0.018). Increasing age was the only significant risk factor for re-operation at 2 years (p value 0.002). Day of surgery payments nearly doubled over the time period from $1712 to $3421.

Conclusion

MPFLR trends over recent years demonstrate increased utilization in a mostly young and healthy patient population. Concomitant lateral release rates have declined while chondroplasty and tibial tubercle osteotomy rates remain stable. Complication rates are low and slowly decreasing over time. Obesity is a risk factor for early re-operation and advancing age a risk factor for re-operation at 2 years. Surgical costs continue to increase over the study period.