Orthopaedic Journal of Sports Medicine · Published 2026-06-01 · DOI 10.1177/23259671251414149
Brock J. Manley, Thomas E. Moran, Jonathan Ham, Joseph Fontana, Alyssa Althoff, Emma L. Klosterman, Robert Browning, David R. Diduch
Background: Patellar instability is common in skeletally immature patients; however, the presence of open physes presents unique challenges to surgical management. Purpose: To (1) assess the safety and efficacy of anatomic medial patellofemoral ligament reconstruction (MPFL-R) in a skeletally immature patient population at short-, mid-, and long-term follow-up and (2) determine the influence of patient factors and surgical and radiographic characteristics on the risk of recurrent instability and clinical outcomes after surgery. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted of the records of skeletally immature patients who underwent primary, anatomic MPFL-R with concomitant procedures at a single academic institution between 2010 and 2019. Patients with <2 years of follow-up were excluded. Demographic data, preoperative radiographic parameters, and surgical details were collected through chart review. Recurrent instability, growth disturbance, and return-to-sport rates were documented via telephone follow-up. The final follow-up included assessment of Kujala, Lysholm, and International Knee Documentation Committee (IKDC) scores. Subgroup analysis focused on patients undergoing isolated MPFL-R. Results: A total of 54 knees in 51 skeletally immature patients with a mean age of 15.6 years (range, 10-18 years) were available for analysis. At a mean follow-up of 8.15 years (range, 55-152 months), 4 of 54 (7.4%) knees experienced subsequent patellar subluxation events. There were no confirmed patellar dislocations, and no patients underwent reoperation for patellar stabilization or growth disturbance. At the final follow-up, the mean Kujala, Lysholm, and IKDC scores were 85.7 (range, 11-100), 83.6 (range, 14-100), and 76.1 (range, 10-95.4), respectively. Patients with a younger age at the time of surgery (hazard ratio, –0.83; 95% CI, –1.53 to −0.14; P = .018) and an increased patellar tendon–to–lateral trochlear ridge (PT-LTR) distance (13.46 vs 8.59 mm; P = .043) demonstrated an increased risk of recurrent patellar instability. Three of 23 (13.0%) knees undergoing isolated MPFL-R, experienced subsequent patellar subluxation events. In subgroup analysis, high-grade trochlear dysplasia ( P = .002) and PT-LTR distance >5.55 mm ( P = .004) correlated with an increased risk of recurrent instability events. Conclusion: Anatomic MPFL-R paired with concomitant procedures as indicated is a safe, efficacious, and durable treatment option for lateral patellar instability in adolescent patients with an open or partially open distal femoral physis.
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Manley, B., Moran, T., Ham, J., et al. (2026). Clinical Outcomes Following Anatomic Medial Patellofemoral Ligament Reconstruction With Concomitant Procedures in Skeletally Immature Patients With Patellar Instability. Orthopaedic Journal of Sports Medicine. https://doi.org/10.1177/23259671251414149