Abstract
Objectives:
Lateral patellar dislocation (LPD) typically occurs in the young and active population but might also affect patients over 30 years of age. Conflicting reports regarding the influence of age at the time of surgery and postoperative patient-reported outcome measures (PROMs) have been reported. Therefore, this study aimed to evaluate whether age at the time of surgery influences patient-reported outcomes (PROMs) in individuals undergoing tailored surgical treatment for recurrent LPD, including deepening trochleoplasty (TP). We hypothesized that patients ≥30 years would achieve PROMs comparable to those <30 years when treated with individualized surgical strategies addressing predisposing anatomical factors for LPD, including TP.
Methods:
This retrospective cohort study used a prospectively maintained database. The Banff Patella Instability Instrument 2.0 (BPII 2.0) and a numerical analog scale (NAS 0-10) for patellofemoral pain (PFP) and subjective knee joint function were used to assess patients’ disease-specific quality of life before and after surgery. Preoperative cartilage status was evaluated via the semiquantitative AMADEUS scoring system.
Results:
Twenty-nine patients (m/f 4/25) were ≥ 30 years of age (mean 35.3; range 30–51) and formed the study group (SG), and 127 patients (m/f 39/88) were < 30 years of age (mean 20.4; range 11–29) and formed the control group (CG). The evaluation was performed at a mean of 30 ± 13.2 (SG) and 33.1 ± 13.3 months (CG) postoperatively (p=0.27). The BPII 2.0 increased from 48.7 ± 21.4 to 85.4 ± 10.7 points (p<0.0001) (SG) and from 44 ± 20.6 to 78.6 ± 18.4 points (p<0.0001) (CG), without any significant difference between the groups at the final follow-up (p=0.24). PFP and subjective knee joint function also improved significantly in both groups (p<0.0001; p<0.0001), without any significant difference between the groups at the final follow-up (p=0.08; p=0.3). In the SG and the CG, 88.2% and 89.7% of patients, respectively, achieved an MCID of 10 points calculated for the BPII 2.0 (p=0.99), and no correlation was found for ‘age’ or any evaluated postoperative PROM (all p>0.1). The AMADEUS scores were 80.1 ± 15 points (CG) and 82.1 ± 14.2 points (SG) (p=0.57), respectively. No correlation was found for ‘AMADEUS’ and postoperative BPII 2.0 scores (p= 0.19; r2= 0.01)
Conclusion:
Deepening TP, as part of a tailored surgical treatment plan for recurrent LPD, yielded satisfying results, irrespective of patient age at the time of surgery.