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How much improvement in patient reported outcomes after isolated medial patellofemoral ligament reconstruction is associated with surgeon-defined satisfactory outcomes? A JUPITER study
James J McGinley, Henry B Ellis, Bennett Propp , Matthew W Veerkamp , Philip L Wilson , Dennis E Kramer, Benton E Heyworth , Sabrina Strickland, Eric Wall, Jason Koh, Yi-Meng Yen, Matthew Halsey, Robert Magnussen, David Roberts, Jack Farr, Daniel Green, Peter Fabricant, Jacqueline Brady, Marc Tompkins Lauren H Redler, Adam B Yanke, Seth L Sherman, Shital N Parikh, Beth E Shubin Stein
J ISAKOS. 2025 Sep 4;15:100997. doi: 10.1016/j.jisako.2025.100997. Online ahead of print.
ABSTRACT
INTRODUCTION: The extent of change in Patient Reported Outcome Measures (PROMs) required to meet surgeon-defined satisfactory outcomes after isolated medial patellofemoral ligament reconstruction (MPFL-R) has not been reported. The primary aim of the study was to define the threshold value of maximal outcome improvement (MOI) in PROMs associated with surgeon-defined satisfactory postoperative outcomes. The secondary aim was to identify the most effective PROM in predicting these outcomes and to evaluate the factors associated with it.
METHODS: This is a retrospective review of prospectively collected data as part of the JUPITER multi-center study. Receiver operating characteristic curves were calculated to determine threshold values for MOI for 4 commonly used PROMs - Banff Patella Instability Instrument (BPII 2.0), Pediatric International Knee Documentation Committee (Pedi-IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Kujala score - associated with surgeon-defined satisfactory outcomes. Multivariate analyses were performed to determine preoperative, intraoperative, and radiographic factors associated with satisfactory outcomes.
RESULTS: 284 patients were included in the analysis. 183 (66.9 %) patients achieved surgeon-defined satisfactory outcomes. For MOI, achieving an improvement in BPII 2.0 score greater than 65.86 % (Area under the curve (AUC): 0.75; CI: 068-0.80; p < 0.0001) and in the Kujala score greater than 85.18 % (AUC: 0.69; CI: 0.62-0.75; p < 0.0001) was associated with a satisfactory outcome. BPII 2.0 had the highest AUC while Kujala had the least AUC (p = 0.04). Multiple logistic regression analysis showed that first-time dislocation or having 10 or more dislocations prior to surgery significantly decreased the odds of achieving satisfactory postoperative outcomes (OR 0.12, p = 0.002). None of the radiographic parameters were associated with outcomes.
CONCLUSION: MOI serves as an important measure to gauge clinical success after isolated MPFL-R. The study sets MOI thresholds for four commonly used PROMs, thus correlating patient- and surgeon-defined satisfactory outcomes after isolated MPFL-R. BPII 2.0 had good discriminative ability while Kujala had the least. The study identifies that isolated MPFL-R after first-time dislocation or after 10 or more dislocations are associated with decreased odds of satisfactory outcomes.
LEVEL OF EVIDENCE: Level 4 retrospective review of prospectively collected data.
PMID:40914394 | DOI:10.1016/j.jisako.2025.100997