Increased Risk of Patellofemoral Instability Events and Surgical Management in Patients With Joint Hypermobility Syndromes: A Matched Cohort Analysis

Abstract

Purpose: To compare the odds of patellofemoral instability events requiring subsequent surgery and revision surgical intervention in patients with joint hypermobility syndromes (JHS) to that of a matched cohort. Methods: This is a retrospective cohort study using the PearlDiver Mariner Database. Records were queried between 2010 and 2021 with a diagnosis of JHS, including Ehlers-Danlos syndrome (EDS) and Marfan syndrome. Propensity matching was performed with a randomly generated control cohort without a diagnosis of JHS to account for age, sex, Charlson comorbidity index, diabetes, and obesity. Multivariable logistic regression was used to compare rates of patellar dislocation over a 1- and 2-year period between the 2 cohorts while controlling for previous knee injury or surgery. Patients who sustained a patellar dislocation over the 2-year period were followed to calculate rates of surgical intervention and subsequent revision. Results: In a population of 91,747, those with JHS experienced patellofemoral instability at a significantly increased rate at both a 1-year (adjusted odds ratio [aOR] 11.40; 95% confidence interval 9.23-14.25, P < .001) and 2-year (aOR 8.73; 7.36-10.44, P < .001) periods. The greatest risk was observed in patients with EDS at 1 year (aOR 16.32; 12.54-21.67, P < .001). Of those with an instability event, patients with JHS experienced a significantly increased rate of surgery at 1 year (aOR 3.20; 1.61-7.28, P = .002) and 2 years (aOR 3.18; 1.70-6.62, P < .001). Of those treated with surgery, there was no significant difference in the rates of revision surgical intervention between the JHS and control cohorts. Conclusions: Patients with JHS experienced significantly increased rates of patellofemoral instability and subsequent surgery. However, of those treated with surgery, there was no difference in rates of revision surgical intervention between those with or without joint hypermobility syndromes. Level of Evidence: Level III, retrospective cohort study.