Purpose To determine which risk factors for patellar instability contribute most relevantly to patients' subjective diseasespeciic quality of life, aiming to provide implications on the overall treatment decision-making process. Methods A total of 182 consecutive patients (male/female 70/112; mean age 23.6 ± 7.3 years) with a history of patellar instability were prospectively enrolled in this study. Patient age, body mass index (BMI), number of dislocations, reversed dynamic patellar apprehension test (ReDPAT), J-sign severity, and pathoanatomic risk factors of patellar instability were assessed. The statistical analysis evaluated the relationships among those variables and determined their ability to predict the Banf Patellofemoral Instability Instrument 2.0 (BPII 2.0) as a disease-speciic quality of life measure. Using Spearman correlation, ANOVA and Fisher's exact test, all variables with ANOVA p ≤ 0.1 or Spearman's abs (rho) > 0.1 were entered into a multivariate linear model using backward-stepwise selection. Results Analysis of the individual variables' ability to predict BPII 2.0 score values revealed 'age', 'BMI', 'ReDPAT', 'high grade of trochlear dysplasia', and 'high-grade J-Sign' as possible relevant factors. Backward-stepwise multivariate regression analysis yielded a inal parsimonious model that included the factors 'BMI' and 'J-Sign (Grade II and III)' as the most relevant parameters inluencing BPII 2.0 score values (adjusted R 2 = 0.418; p < 0.001), with a cutof value for BMI found at 28 kg/m 2 (p = 0.01). ConclusionThe results of this study indicate that in patients with lateral patellar instability, a high-grade J-sign and an increased BMI signiicantly impact subjective disease-speciic quality of life. Level of evidence Level IV.
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