Title : Early surgical stabilization with physeal-sparing MPFL reconstruction vs. Conservative care for pediatric first-time patellar dislocations: Two-year results of a randomized controlled trial

Objective: Children have unique physeal anatomy and high functional demands after first-time traumatic patellar dislocation. This study aims to compare the clinical and radiological outcomes of standardized non-operative management versus early operative intervention using a specific physeal-sparing surgical technique.

Methods: This is a single-center, prospective, randomized controlled trial. We enrolled 120 skeletally immature patients (aged 10–15 years) with a first-time acute traumatic patellar dislocation and distal femoral physes. Patients with concomitant multi-ligament injuries or prior ipsilateral knee surgery were excluded. Following stratification by baseline TT-TG distance and trochlear morphology, patients were block-randomized 1:1 into two groups: Non-operative group (group A) and Operative – Physeal-Sparing MPFL Reconstruction group (group B). Primary outcome measures were: (1) the redislocation rate at 24-month follow-up, and (2) the Kujala Patellofemoral Score. Secondary outcomes included the Tegner Activity Scale and MRI-assessed cartilage integrity (Whole-Organ Magnetic Resonance Imaging Score [WORMS]) at final follow-up.

Results: At a minimum 1-year follow-up (93% retention), the operative group demonstrated a significantly lower redislocation rate (5.0%, n=3/56) compared to the non-operative group (37.5%, n=21/56) (p<0.001). The mean Kujala score was superior in the surgical cohort (92.4 ± 6.1 vs. 78.6 ± 10.4, p<0.01). Notably, while the operative group had a higher initial cost and surgical morbidity, they exhibited a significantly lower incidence of new osteochondral lesions on follow-up MRI compared to the conservatively managed group (8.9% vs. 28.6%, p=0.02). No iatrogenic physeal arrest or growth disturbance occurred in any surgical patient, confirming the safety of the physeal-sparing femoral tunnel technique.

Conclusion: The results provide high-level evidence that, in pediatric patients with open physes, early anatomical MPFL reconstruction using a strict physeal-sparing gracilis autograft technique is safe and significantly superior to non-operative management for preventing recurrent instability and protecting articular cartilage.

To be updated shortly..