Trends and Complications of Medial Patellofemoral Ligament Reconstruction Among Applicants for the American Board of Orthopaedic Surgery Part II and Maintenance of Certification Examinations: Analysis of Data Over a 15-Year Period

Background: Medial patellofemoral ligament reconstruction (MPFLR) and tibial tubercle osteotomy (TTO) are commonly performed surgical procedures that often have a high learning curve.

Purpose: To review the American Board of Orthopaedic Surgery (ABOS) Part II oral examination case list and the Maintenance of Certification (MOC) examination case list databases for trends in MPFLR (isolated and with concurrent TTO) and complication rates.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: We reviewed the ABOS Part II and MOC case list databases for diagnosis codes relating to patellar instability and Current Procedural Terminology codes specific to MPFLR and TTO regarding cases submitted by applicants for these examinations between 2003 and 2017 (for ABOS Part II) and between 2010 and 2017 (for MOC). Data were analyzed using generalized estimating equations with a binomial distribution and logit link to determine how trends in MPFLR changed over the study period in these applicant groups (ABOS vs MOC) as well as any influence on complication rates.

Results: In the ABOS group, the number of MPFLRs performed by surgeons increased a mean 3% each year, ranging from 66 in 2003 to 184 in 2015 (injury rate ratio, 1.03; 95% CI, 1.02-1.04; P < .001). In the MOC group, the mean number of MPFLRs did not change significantly (range, 119 in 2011 vs 230 in 2013; P = .772). In the ABOS group, after adjusting for patient age and examination year, MPFLR combined with TTO was associated with 92% greater odds of having a complication versus isolated MPFLR (odds ratio, 1.92; 95% CI, 1.24-2.98; P = .004), whereas the MOC group demonstrated no significant difference in the odds of having a complication between cases with versus without a concurrent TTO (P = .214).

Conclusion: In the current study, the number of MPFLRs performed by the less experienced surgeons in the ABOS group increased a mean 3% each year, whereas this number remained stable for the more experienced MOC group. Additionally, there were significantly more complications with MPFLR and concomitant TTO among the ABOS Part II candidates compared with the MOC candidates. These findings may be helpful in surgical decision making and education in patellofemoral instability.