{"doi":"10.1016/j.arthro.2020.03.033","title":"Author Reply to “Regarding “Primary Medial Patellofemoral Ligament Repair Versus Reconstruction: Rates and Risk Factors for Instability Recurrence in a Young, Active Patient Population”","abstract":"First and foremost, we would like to thank Dr. Ilahi for his thoughtful commentary on our recent publication.1Puzzitiello R.N. Waterman B. Agarwalla A. et al.Primary medial patellofemoral ligament repair versus reconstruction: Rates and risk factors for instability recurrence in a young, active patient population.Arthroscopy. 2019; 35: 2909-2915Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Our referenced study comparatively analyzed the outcomes of 32 medial patellofemoral ligament (MPFL) reconstructions and 19 MPFL repairs. At an average follow-up of approximately 5 years, there was a 6.3% re-dislocation rate among reconstructions compared with 36.9% among repairs. The follow-up duration for repair and reconstruction was 6.5 years and 3.7 years, respectively.1Puzzitiello R.N. Waterman B. Agarwalla A. et al.Primary medial patellofemoral ligament repair versus reconstruction: Rates and risk factors for instability recurrence in a young, active patient population.Arthroscopy. 2019; 35: 2909-2915Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar The primary concern mentioned by Dr. Ilahi was the relatively high failure rate, defined as recurrent patellar dislocation, following MPFL repair compared anecdotally with his own surgical experience. He postulates that our inclusion of patients with a single patellar dislocation event could account for this difference. In the current study, there were a significantly greater number of patients with only a single patellar dislocation before surgery in the MPFL repair group (36.9%) compared with the reconstruction group (3.1%). However, previous evidence would suggest that this would actually favor the outcomes of the MPFL repair group. It has previously been observed in the epidemiologic study by Fithian et al.2Fithian D.C. Paxton E.W. Stone M.L. et al.Epidemiology and natural history of acute patellar dislocation.Am J Sports Med. 2004; 32: 1114-1121Crossref PubMed Scopus (732) Google Scholar that only 17% of patients who sustain a first-time patellar dislocation event go on to experience a second dislocation, as opposed to the 49% with a history of previous instability who suffered a subsequent dislocation event. Further, it is also possible for patients with a single patellar dislocation to not respond to nonsurgical management without a second dislocation, such as in patients with provocative apprehension or positional subluxation. Nonetheless, there remains a paucity of high-quality studies that attempt to identify the best treatment option for patients after a single patellar dislocation, and this topic remains controversal.3Pagliazzi G. Napoli F. Previtali D. Filardo G. Zaffagnini S. Candrian C. A Meta-analysis of surgical versus nonsurgical treatment of primary patella dislocation.Arthroscopy. 2019; 35: 2469-2481Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Although the inclusion of these patients in our study may have made our study population less homogenous, it is unlikely that this could explain the high failure rate among MPFL repairs. Dr. Ilahi also suggests that it is possible that the suture size and rehabilitation protocol used for the MPFL repair group in our study also may account for the high failure rate. These are 2 variables that could very well influence outcomes for this procedure, but these are factors that are often highly variable among different surgeons for many orthopaedic procedures. It is unlikely that these 2 factors alone could account for such a significantly greater failure rate. However, it is more likely that additional anatomic features, such as patella alta, could influence the unfavorable outcomes after MPFL repair, and this is supported by recent evidence. In our study, we found the average Caton–Deschamps index of the MPFL failures was 1.30, which was significantly greater than the MPFL non-failure group.1Puzzitiello R.N. Waterman B. Agarwalla A. et al.Primary medial patellofemoral ligamen","journal":"Arthroscopy The Journal of Arthroscopic and Related Surgery","year":2020,"id":116746,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9551,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":369519,"name":"Avinesh Agarwalla","orcid":"0000-0001-5056-6780","position":1,"is_corresponding":false},{"id":455321,"name":"Brian R. Waterman","orcid":"0000-0002-1442-212X","position":2,"is_corresponding":false},{"id":286517,"name":"Nikhil N. Verma","orcid":"0000-0001-9875-2769","position":3,"is_corresponding":false},{"id":286518,"name":"Brian J. Cole","orcid":"0000-0002-4006-2113","position":4,"is_corresponding":false},{"id":286516,"name":"Adam B. Yanke","orcid":"0000-0002-9601-4217","position":5,"is_corresponding":false},{"id":341535,"name":"Brian Forsythe","orcid":"0000-0003-1665-5872","position":6,"is_corresponding":false},{"id":369521,"name":"Richard N. Puzzitiello","orcid":"0000-0002-2435-4220","position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":null,"created_at":"2026-07-18T23:13:47.803267Z","pmid":"32503766","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}