A Prospective Cohort Study on Quality of Life among the Pediatric Population after Surgery for Recurrent Patellar Dislocation

Abstract

Patellofemoral instability is a frequent cause of knee pathology affecting quality of life among the pediatric population. Here, we present a prospective cohort study which included patients who had undergone surgical management using the lateral release and medial imbrication approach (LRMI) or medial patellofemoral ligament reconstruction (MPFL-R). The object of this study was to assess the quality of life among children that have undergone surgical treatment for patellar dislocation. Quality of life was assessed before and after surgery using the Pediatric International Knee Documentation Committee form (Pedi-IKDC), a questionnaire that aims to quantify knee functionality. Postoperative scarring was evaluated using The Stony Brook Scar Evaluation Scale. One hundred and eight patients were selected and grouped according to the type of procedure. Before surgery, the two groups had similar mean Pedi-IKDC scores (41,4 MPFL-R vs. 39,4 LRMI p = 0.314). Improvements were observed in the postoperative scores. The MPFL-R technique showed promising outcomes. When comparing the two surgical groups, there was a significant difference in favor of MPFL-R group (MPFL-R 77.71 points vs. LRMI 59.74 points, p < 0.0001–95% CI (11.22–24.72)). Using the Stony Brook Scar Evaluation Scale, a significant difference in scar quality in favor of MPFL-R was observed (4,5 MPFL-R vs. 2,77 LRMI p = 0.002). In conclusion, this study provides objective evidence-based outcome assessments that support the medial patellofemoral ligament reconstruction technique as the gold standard for patellofemoral instability.

Portuguese Cross-Cultural Adaptations of the Pediatric International Knee Documentation Committee Score

“…It consists of 19 questions about knee symptoms, function and impact on physical activities. This survey has been extensively used in the literature, [11][12][13][14][15] and a recently published systematic review showed that Pedi-IKDC is the most studied PROM and has the best psychometric properties and, as such, should be preferred in detriment of other instruments. 12 The Pedi-IKDC was already validated in many other languages, [15][16][17] with the validation studies being conducted in pediatric populations affected by a broad spectrum of knee injuries and disorders.…”

Quality of life following medial patellofemoral ligament reconstruction combined with medial tibial tubercle transfer in patients with recurrent patellar dislocation: a retrospective comparative study

“…Numerous studies reported significant improved QoL after iMPFLr using different methods, including EQ-5D-3L, Knee Injury and Osteoarthritis Outcome Score (KOOS), Pediatric International Knee Documentation Committee Form (Pedi-IKDC), Banff Patella Instrumentation and Short Form 12 (SF-12), but none of them mentioned psychometric effects [ 14 , 36 , 39 , 40 ]. Bouras et al used EQ-5D-3L questionnaire to evaluate the Qol after iMPFLr and noted that EQ-5D index and EQ-5D VAS significantly increased at last follow-up [ 14 ].…”

“…One possible reason was the standard postoperative rehabilitation protocol adopted in this study, including rapid postoperative activities and quadriceps femoris strength training, which prevented muscle atrophy caused by immobilization. Another reason was that MPFLr and TTT were able to reestablish the normal anatomy of the knee, promote normal joint reaction forces and restore patellofemoral stability, which contributed to the relief of pain and related symptoms that affected general health conditions, including mental health [ 40 ]. Therefore, postoperative improvements in clinical evaluation, including functional outcomes, and radiological evaluation lead to the improvement of Qol.…”

Framing Patellar Instability: From Diagnosis to the Treatment of the First Episode

“…Considering the severity of the deformity, several surgical treatments can be taken into consideration. These include both arthroscopic and open MPFL repair or reconstruction, which have shown promising outcomes in recent studies [ 40 , 41 , 42 ]. Additionally, Fulkerson-type osteotomy has emerged as an effective approach in addressing complex cases [ 43 ].…”