Treating patellofemoral instability (PFI) in children and adolescents remains a challenge given the lack of clear clinical guidelines, especially when it comes to surgical intervention. Recent research from the JUPITER study analyzed surgeries performed between 2016 and 2021 and highlights that, even among 20 high-volume orthopedic surgeons across 13 academic centers, substantial variation persists in how MPFL reconstruction is performed in skeletally immature patients.
Among 245 qualifying knee surgeries in the JUPITER study, there were large discrepancies in tendon graft selection (59% allograft vs. 41% autograft), methods of patellar fixation (62% suture anchor, 32% bone bridge/tunnel), and femoral fixation strategies (76% screw, 23% suture anchor). Every case utilized fluoroscopic guidance and bone-sparing principles to protect the growing skeleton, while a minority included additional procedures, such as lateral release or fracture treatment.
The JUPITER study is a general survey of the different ways that surgeons perform MPFL surgery. I don’t think it will change the way surgeons do surgery, but it is interesting to see how different surgeons practice. The findings reinforce that, despite common goals and similar patient populations, specific surgical decisions remain highly individualized among experts.
Read the study in the Orthopaedic Journal of Sports Medicine: Variation in Surgical Technique for Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: Data From the JUPITER Prospective Multicenter Study Group
