Factors Associated With Pain and Function Before Medial Patellofemoral Ligament Reconstruction

Abstract

Background: Medial patellofemoral ligament (MPFL) reconstruction is performed to treat recurrent patellar instability. Measurement of joint pain and function at the time of surgery has been demonstrated to be a predictor of the final outcomes in many surgical procedures. Purpose/Hypothesis: The purpose of this study was to evaluate the relationship between baseline patient characteristics, mental health, and intraoperative findings and patient-reported knee pain and function at the time of MPFL reconstruction. We hypothesized that patient characteristics and associated pathology would be associated with the degree of pain and dysfunction. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were skeletally mature patients who underwent unilateral open MPFL reconstruction between 2015 and 2020 at a single institution. Baseline descriptive information was collected, and the following outcome measures were administered preoperatively: the Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, Physical Function Short Form (PS), and Quality of Life (QoL) subscales. Intraoperative findings were collected in a standardized format. Patient characteristics, preoperative variables, intraoperative findings, and VR-12 MCS were used as risk factors, and multivariate analysis was conducted to assess for relationships with the KOOS subscale scores. Results: In total, 201 patients with patella dislocations were included in this analysis. Intraoperatively, 122 patients (60.7%) had either normal cartilage or grade 1 or 2 cartilage injury, 79 patients (39.3%) had grade 3 or 4 cartilage injury, 35 patients (17.4%) had a loose body, and 3 patients (1.49%) had evidence of synovitis. Younger age ( P = .012), male sex ( P < .001), never having smoked ( P = .029), and lower baseline VR-MCS ( P < .001) were significantly associated with higher baseline KOOS Pain scores. Older age ( P = .035), female sex ( P = .003), higher body mass index ( P = .005), and lower baseline VR-12 MCS ( P < .001) were significantly associated with higher baseline KOOS PS scores. Younger age ( P = .003), male sex ( P < .001), lower baseline VR-12 MCS ( P < .001), and no dysplasia ( P = .023) were significantly associated with higher baseline KOOS QoL scores. Conclusion: Patient age, sex, and baseline VR-12 MCS were associated with all 3 baseline KOOS subscale scores, whereas intraoperative findings outside of trochlear dysplasia were not associated with any of the KOOS subscale scores.