MPFL reconstruction vs. Insall procedure for adolescent patellar instability: nine-year follow-up on osteoarthritis, redislocations, and return to sports
Abstract Background Medial patellofemoral ligament reconstruction (MPFLR) has become increasingly common in treating patellofemoral instability (PFI). Previously, proximal realignment surgeries, such as Insall’s procedure, were preferred in adolescents with open physes. More evidence is needed on th...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-08-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-025-08992-3 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849344334704410624 |
|---|---|
| author | Maija Jääskelä Marja Perhomaa Lasse Lempainen Jaakko Sinikumpu |
| author_facet | Maija Jääskelä Marja Perhomaa Lasse Lempainen Jaakko Sinikumpu |
| author_sort | Maija Jääskelä |
| collection | DOAJ |
| description | Abstract Background Medial patellofemoral ligament reconstruction (MPFLR) has become increasingly common in treating patellofemoral instability (PFI). Previously, proximal realignment surgeries, such as Insall’s procedure, were preferred in adolescents with open physes. More evidence is needed on the long-term outcomes of MPFLR and Insall’s procedures, particularly regarding the risk of early postoperative osteoarthritis and redislocation. Methods A total of 129 patients under 17 years of age who underwent surgery for PFI between 2005 and 2019, with a minimum follow-up time of 24 months, were retrospectively evaluated. Inclusion criteria comprised isolated medial patellofemoral ligament reconstruction (MPFLR) or Insall’s proximal realignment with at least partially open physes at surgery and residence within the hospital district to enable follow-up. Of the 129 patients, 31 met the inclusion criteria, and 24 patients (25 knees; 77%) participated in long-term clinical and radiographic follow-up. Most patients were female (62%) with a mean surgery age of 14.5 ± 1.3 years. Osteoarthritis, redislocations, return to sports, subjective knee-specific recovery, and health-related quality of life were investigated. The mean follow-up time 9 years (range 2 to 18). The long-term outcomes were compared between the treatment groups. Results Patellofemoral osteoarthritis (Kellgren and Lawrence II–IV) was found in one knee (6.7%) after MPFLR and in six (60%) knees after Insall’s procedure (P =.004). No tibiofemoral osteoarthritis was found after MPFLR but was present in four (40%) knees after Insall’s (P =.008). No MPFLR patients required reoperation compared to a 40% (4/10) in the Insall’s group (P =.008). At follow-up 26.7% (4/15) of MPFLR and 80% 8/10) of Insall’s patients were unable to return in pivoting sports due to residual symptoms (P =.008). No significant differences were found in IKDC (MPFLR 77.8 [SD 14.9] vs. Insall ‘s77.5 [SD 18.4], P = 0.973) or Lysholm scores (MPFLR 80.5 [SD 12.9] vs. Insall’s 77.1 [15.2], P = 0.589). Conclusion MPFLR showed superior long-term outcomes compared to Insall’s procedure in skeletally immature patients with recurrent PFI, with lower rates of osteoarthritis and reoperation. |
| format | Article |
| id | doaj-art-42eace507ff942e384f1710e7e2691d0 |
| institution | Kabale University |
| issn | 1471-2474 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-42eace507ff942e384f1710e7e2691d02025-08-20T03:42:41ZengBMCBMC Musculoskeletal Disorders1471-24742025-08-0126111010.1186/s12891-025-08992-3MPFL reconstruction vs. Insall procedure for adolescent patellar instability: nine-year follow-up on osteoarthritis, redislocations, and return to sportsMaija Jääskelä0Marja Perhomaa1Lasse Lempainen2Jaakko Sinikumpu3Department of Pediatric Orthopaedics and Surgery, Research Unit of Clinical Medicine, Oulu University Hospital, University of Oulu; and Medical Research CenterDepartment of Pediatric Orthopaedics and Surgery, Research Unit of Clinical Medicine, Oulu University Hospital, University of Oulu; and Medical Research CenterFinnOrthopaedics/Hospital PihlajalinnaDepartment of Pediatric Orthopaedics and Surgery, Research Unit of Clinical Medicine, Oulu University Hospital, University of Oulu; and Medical Research CenterAbstract Background Medial patellofemoral ligament reconstruction (MPFLR) has become increasingly common in treating patellofemoral instability (PFI). Previously, proximal realignment surgeries, such as Insall’s procedure, were preferred in adolescents with open physes. More evidence is needed on the long-term outcomes of MPFLR and Insall’s procedures, particularly regarding the risk of early postoperative osteoarthritis and redislocation. Methods A total of 129 patients under 17 years of age who underwent surgery for PFI between 2005 and 2019, with a minimum follow-up time of 24 months, were retrospectively evaluated. Inclusion criteria comprised isolated medial patellofemoral ligament reconstruction (MPFLR) or Insall’s proximal realignment with at least partially open physes at surgery and residence within the hospital district to enable follow-up. Of the 129 patients, 31 met the inclusion criteria, and 24 patients (25 knees; 77%) participated in long-term clinical and radiographic follow-up. Most patients were female (62%) with a mean surgery age of 14.5 ± 1.3 years. Osteoarthritis, redislocations, return to sports, subjective knee-specific recovery, and health-related quality of life were investigated. The mean follow-up time 9 years (range 2 to 18). The long-term outcomes were compared between the treatment groups. Results Patellofemoral osteoarthritis (Kellgren and Lawrence II–IV) was found in one knee (6.7%) after MPFLR and in six (60%) knees after Insall’s procedure (P =.004). No tibiofemoral osteoarthritis was found after MPFLR but was present in four (40%) knees after Insall’s (P =.008). No MPFLR patients required reoperation compared to a 40% (4/10) in the Insall’s group (P =.008). At follow-up 26.7% (4/15) of MPFLR and 80% 8/10) of Insall’s patients were unable to return in pivoting sports due to residual symptoms (P =.008). No significant differences were found in IKDC (MPFLR 77.8 [SD 14.9] vs. Insall ‘s77.5 [SD 18.4], P = 0.973) or Lysholm scores (MPFLR 80.5 [SD 12.9] vs. Insall’s 77.1 [15.2], P = 0.589). Conclusion MPFLR showed superior long-term outcomes compared to Insall’s procedure in skeletally immature patients with recurrent PFI, with lower rates of osteoarthritis and reoperation.https://doi.org/10.1186/s12891-025-08992-3Patellar lateral dislocationPatellofemoral instabilitySkeletal immaturityMPFL reconstructionProximal realignment procedureOsteoarthritis |
| spellingShingle | Maija Jääskelä Marja Perhomaa Lasse Lempainen Jaakko Sinikumpu MPFL reconstruction vs. Insall procedure for adolescent patellar instability: nine-year follow-up on osteoarthritis, redislocations, and return to sports BMC Musculoskeletal Disorders Patellar lateral dislocation Patellofemoral instability Skeletal immaturity MPFL reconstruction Proximal realignment procedure Osteoarthritis |
| title | MPFL reconstruction vs. Insall procedure for adolescent patellar instability: nine-year follow-up on osteoarthritis, redislocations, and return to sports |
| title_full | MPFL reconstruction vs. Insall procedure for adolescent patellar instability: nine-year follow-up on osteoarthritis, redislocations, and return to sports |
| title_fullStr | MPFL reconstruction vs. Insall procedure for adolescent patellar instability: nine-year follow-up on osteoarthritis, redislocations, and return to sports |
| title_full_unstemmed | MPFL reconstruction vs. Insall procedure for adolescent patellar instability: nine-year follow-up on osteoarthritis, redislocations, and return to sports |
| title_short | MPFL reconstruction vs. Insall procedure for adolescent patellar instability: nine-year follow-up on osteoarthritis, redislocations, and return to sports |
| title_sort | mpfl reconstruction vs insall procedure for adolescent patellar instability nine year follow up on osteoarthritis redislocations and return to sports |
| topic | Patellar lateral dislocation Patellofemoral instability Skeletal immaturity MPFL reconstruction Proximal realignment procedure Osteoarthritis |
| url | https://doi.org/10.1186/s12891-025-08992-3 |
| work_keys_str_mv | AT maijajaaskela mpflreconstructionvsinsallprocedureforadolescentpatellarinstabilitynineyearfollowuponosteoarthritisredislocationsandreturntosports AT marjaperhomaa mpflreconstructionvsinsallprocedureforadolescentpatellarinstabilitynineyearfollowuponosteoarthritisredislocationsandreturntosports AT lasselempainen mpflreconstructionvsinsallprocedureforadolescentpatellarinstabilitynineyearfollowuponosteoarthritisredislocationsandreturntosports AT jaakkosinikumpu mpflreconstructionvsinsallprocedureforadolescentpatellarinstabilitynineyearfollowuponosteoarthritisredislocationsandreturntosports |