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Patellar (or Kneecap) Instability and Mal-alignmentANTI-GLIDENCT06926699

MPFL Reconstruction Versus Rehabilitation

A study testing Medial Patellofemoral Ligament Reconstruction and Rehabilitation in people with Patellar (or Kneecap) Instability and Mal-alignment and Patellar Dislocation, run by McMaster University.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

This study involves patients between the ages of 16 and 25 and have been diagnosed with a first-time traumatic patellar dislocation within the past 3 months. McMaster University and the investigators are receiving compensation from the Arthroscopy Association of North America to cover the costs of conducting the… Read more about this study

Who is it for?
Ages 10 to 25 years
What is being tested?
Medial Patellofemoral Ligament Reconstruction and Rehabilitation
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
0 participants
Where
No sites listed yet
Study dates
1 Jan 2026to 5 Oct 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 10 to 25 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Males and female patients under the age of 25 inclusive but greater than 10 years of age inclusive
  • Patients with first-time traumatic lateral patellar dislocation presenting within 6 months from time of injury
  • Lateral patellar dislocation confirmed by radiography, MRI demonstrating sequela of lateral patellar dislocation after injury to the knee, demonstration of patellar apprehension, J-sign or patellar glide grade 3 or greater on physical exam following injury to the knee
  • Patients who have the ability to speak, understand, and read English
  • Provision of informed consent or parental consent

Who cannot join

  • Previous dislocation episodes or instability of the affected patella
  • Previous surgeries involving the affected knee
  • History or clinical exam findings of generalized ligamentous laxity (defined as Beighton score of 4 or more points)
  • TT-TG distance >20mm as determined by MRI
  • Evidence of severe trochlear dysplasia on MRI as determined by Dejour classification type D dysplasia
  • Loose bodies or osteochondral fractures as confirmed on MRI
Show all 10Show fewer
  • A neurovascular injury of the affected leg
  • Patients who will likely have problems, in the judgment of the investigator, with maintaining follow-up
  • Any other reason(s) the investigator feels is relevant for excluding the patient
  • Patients requiring concomitant arthrotomy for osteochondral fracture fixation (however microfracture and arthroscopic loose body removal for loose bodies found on arthroscopic assessment are not exclusion criteria)

About this study

Official title: RehAbilitatioN Versus Early Medial PaTellofemoral LIGament Reconstruction in Patients With Acute First-Time PateLlar DIslocation: A Pilot RanDomized ControllEd Trial

This study involves patients between the ages of 16 and 25 and have been diagnosed with a first-time traumatic patellar dislocation within the past 3 months. McMaster University and the investigators are receiving compensation from the Arthroscopy Association of North America to cover the costs of conducting the study.

Dislocations of the kneecap or patella is often treated without surgery, however up to 50% of patients will unfortunately experience recurrent instability of the patella. These episodes can cause damage to the bones and cartilage in the knee, which can result in long-term knee pain or weakness. Therefore, there is increasing interest to consider treating the knee with surgery right away in this population.

Read more

The purpose of this study is to determine the effect of medial patellofemoral ligament (MPFL) reconstruction compared to rest and physical rehabilitation on the rate of repeat patella dislocation, pain, and knee function for patients with their first patellar dislocation. The investigators will follow patients for at least one year after assigned treatment is started. Outcomes will be measured using surveys and checking medical records over the course of the study. The pilot will test this research study on a smaller scale before conducting a larger study. Patients will not be asked to attend additional visits outside of their typical follow-up schedule with their doctor.

There will be 30 patients recruited in total for this pilot study. Not all patients diagnosed with a patellar dislocation will be eligible to participate. Participation will be required at 6 regularly scheduled appointments that patients would need to attend to see the surgeon (even if they were not in the trial), including the screening visit, surgery date (if randomized to that treatment), 2-week, 6-week, 3-month, 6-month, and 12-month follow-up visits. Patients will be asked how they feel via various questionnaires and should take no longer than 15-20 minutes to complete the research forms at each visit.

If patients agree to participate in this study, treatment will be determined by a process called randomization. Randomization means that the treatment the patient receives will be decided by chance like flipping a coin. Patients will have a 1-in-2 chance of receiving one of the following treatments:

Read the detailed description

Patellar dislocation is a common orthopedic injury, with an overall incidence of acute first-time dislocation ranging between 2.3 and 23.2 per 100 000 person years, occurring often secondary to a non-contact flexion-rotation injury. The medial patellofemoral ligament (MPFL) is an hourglass shaped structure that originates on the superomedial aspect of the patella, and inserts onto the medial femoral epicondyle. This ligament is essential, as it serves as a primary checkrein to lateral patellar translation between 0-30 degrees of knee flexion. Surgical intervention often aims to replace this ligament to recreate this checkrein, in the form of MPFL reconstruction. Traditionally, patients who have sustained first-time patellar dislocations have been treated nonoperatively, and surgical intervention has mostly been reserved for patients with recurrent dislocations. However, the evidence behind this decision-making process is limited.

Specifically, a recently published a systematic review and meta-analysis comparing early MPFL reconstruction with rehabilitation, finding a pooled recurrent dislocation rate of 7% (95%CI 2-17%) in the reconstruction group compared to 30% (95%CI 25-36%) in the rehabilitation group. Another meta-analysis reported inferior rates of recurrent dislocation with rehabilitation (30%, 95%CI 25-36%) compared to acute MPFL repair (7%, 95%CI 3-12%). These findings were again found in the pediatric population, as reported by another meta-analysis published by our group, finding a pooled recurrent dislocation rate of 25.1% in the surgical group, compared with 46.4% in the conservative management group. When stratifying results by type of surgical procedure performed, the MPFL reconstruction group had a recurrent dislocation rate of 3.1% compared to that of other procedures, such as MPFL repair, lateral release, or medial imbrication, with a recurrent dislocation rate of 39.4%.

There have only been two prospective studies comparing MPFL reconstruction with rehabilitation for first-time dislocation. Based on the minimal number of adverse events, these studies demonstrated safety of early surgical intervention in first-time patellar dislocations, in addition to lower rates of recurrent patellar instability. However, allocation into treatment groups was not randomized in one study while the other study had a small sample size of only 39 patients which may bias and limit the applicability of the results.

This is a pilot randomized controlled trial (RCT) that will determine in patients under 25 years old with acute first-time patellar dislocations, the effect of early medial patellofemoral ligament (MPFL) reconstruction vs rehabilitation on recurrent dislocation rates, anterior knee pain, patient reported functional outcomes and complication rates at 12 months. The rationale for this trial is based on 1) the burden of patellar instability in the general population, 2) the high risk of progression to recurrent instability, 3) serious long-term, deleterious effects to the knee with recurrent instability, 4) the lack of definitive evidence or guidelines on the optimal treatment strategy in patients with these injuries, 5) promising results seen with early MPFL reconstruction in previous smaller studies, 6) lack of well-powered, high-quality, RCTs assessing early MPFL reconstruction after an acute first-time patellar dislocation patients. This trial is important and novel because it will provide surgeons with high-quality level I evidence to guide treatment decisions in patients with acute first-time patellar dislocations.

Being tested
Medial Patellofemoral Ligament Reconstruction, Rehabilitation
Keywords
MPFL, Medial Patellofemoral Ligament Reconstruction, Patellar dislocation
Medical subject headings
Patella Fracture, Patellar Dislocation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Medial Patellofemoral Ligament ReconstructionProcedure or surgery

    An initial evaluation with a diagnostic knee arthroscopy is done to ensure there are no loose bodies or osteochondral lesions missed on MRI that require removal or fixation. Graft harvest and preparation is done using either an autograft or allograft tendon as per a shared decision-making approach between the surgeon and patient. A 2cm longitudinal incision is made over the anteromedial aspect of the patella and dissection done between the second and third layers. Fixation (variable depending on surgeon preference) is performed over the proximal half of the patella. Another skin incision is then made over the medial femoral epicondyle with a guide pin passed through Schottle's point. The proximal femoral cortex is then drilled overtop of the guide pin to a diameter equal to the graft diameter with the remainder of the femoral tunnel drilled to 4.5mm.The graft ends are tied to the patellar fixation and shuttled through the second and third layers and fixed to the femur.

  • RehabilitationOther

    Patients will be initially placed in a patellar stabilizing brace and told to remain non weight-bearing for the first two weeks. Subjects will be permitted to perform gentle ROM exercises while in the knee brace with progressive weight-bearing as tolerated permitted at the 2-week mark. Formal physiotherapy commences at 2-weeks post-enrollment, with a goal of return to activities or sport at 6-months post-enrollment.

Study groups in NCT06926699
Study groupRoleWhat they receive
Medial Patellofemoral Ligament ReconstructionExperimentalAn initial evaluation with a diagnostic knee arthroscopy is done to ensure there are no loose bodies or osteochondral lesions missed on MRI that require removal or fixation. Graft harvest and preparation is done using either an autograft or allograft tendon as per a shared decision-making approach between the surgeon and patient. A 2cm longitudinal incision is made over the anteromedial aspect of the patella and dissection done between the second and third layers. Fixation (variable depending on surgeon preference) is performed over the proximal half of the patella. Another skin incision is then made over the medial femoral epicondyle with a guide pin passed through Schottle's point. The proximal femoral cortex is then drilled overtop of the guide pin to a diameter equal to the graft diameter with the remainder of the femoral tunnel drilled to 4.5mm.The graft ends are tied to the patellar fixation and shuttled through the second and third layers and fixed to the femur.
Receives: Procedure: Medial Patellofemoral Ligament Reconstruction
RehabilitationActive comparatorPatients will be initially placed in a patellar stabilizing brace and told to remain non weight-bearing for the first two weeks. Subjects will be permitted to perform gentle ROM exercises while in the knee brace with progressive weight-bearing as tolerated permitted at the 2-week mark. Formal physiotherapy commences at 2-weeks post-enrollment, with a goal of return to activities or sport at 6-months post-enrollment.
Receives: Other: Rehabilitation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Recurrent dislocation and instability

    1. The rate of recurrent patellar dislocation at 12 months
    2. The rate of recurrent subjective instability at 12 months
    3. The rate of recurrent instability requiring surgical management at 12 months

    Measured: 12 months post- start of intervention

Secondary outcomes (6)
  1. Visual Analogue Score (VAS)

    The VAS is one of the most commonly used pain rating scores in both research and clinical practice, it is an easy-to-use, validated, one-dimensional scale from 0-10

    Measured: 12 months post- start of intervention

  2. Kujala Anterior Knee Pain Scale

    The Kujala Anterior Knee Pain scale is a 13-item screening instrument used to assess patellofemoral pain in adolescents and young adults, with a variable ordinal response format. Total scores range from 0-100.

    Measured: 12 months post- start of intervention

  3. Banff Patellofemoral Instability Index 2.0 (BPII2.0)

    The Banff Patellofemoral Instability Index 2.0 (BPII 2.0) Score is a metric of quality of life with multiple domains and subdomains having participants rate items from 0-100

    Measured: 12 months post- start of intervention

  4. Tegner Activity Scale

    The Tegner activity scale is a numerical scale with each value (0-10) representing specific activities An individual participating in competitive sports has an activity level of 10. An individual participating in recreational sports has an activity level of 6. An individual on sick leave or disability pension due to knee problems has an activity of 0

    Measured: 12 months post- start of intervention

  5. Adverse Events

    Occurrence of adverse events such as patellar fracture, patellar cartilage lesion or other events (other than recurrent patellar dislocations), obtaining a subsequent MRI to evaluate for pathology, and secondary chondral injury not present on an initial MRI if recurrent MRI is performed

    Measured: 12 months post- start of intervention

  6. Recurrent Instability of the Patella score

    Will also aim to validate the Recurrent Instability of the Patella score, this will help determine which patients may benefit from surgical intervention for first-time dislocation by classifying their risk of recurrent dislocation as either low, intermediate, or high based on preoperative factors.

    The Recurrent Instability of the Patella score consists of four factors: age <25 years (worth 2 points), skeletal immaturity (worth 1 point), Dejour A-D dysplasia (worth 1 point), and TT-TG/patellar length >= 0.5 (worth 1 point), for a maximum score of 5. Scores of 0-1 are deemed as low risk, 2-3 as intermediate risk, and 4-5 points as high risk.

    Measured: 12 months post- start of intervention

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Apr 2025
  2. Study start1 Jan 2026
  3. Primary completion5 Oct 2026
  4. Study completion5 Oct 2026

Why it stopped: No participants recruited

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06926699
Sponsor's protocol ID
ANTI-GLIDE
Other IDs
$25000
Acronym
ANTI-GLIDE
Status last verified
Oct 2026
First submitted
11 Apr 2025
Last updated
7 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: IPD will not be shared to avoid risks of compromising patient confidentiality.

Questions about this trial

What is this clinical trial studying?

A study testing Medial Patellofemoral Ligament Reconstruction and Rehabilitation in people with Patellar (or Kneecap) Instability and Mal-alignment and Patellar Dislocation, run by McMaster University.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: withdrawn, as of the sponsor's last update on 7 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was withdrawn before enrolling participants, so there are no results.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Recurrent dislocation and instability (time frame: 12 months post- start of intervention). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Oct 2026.

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