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. 2025 Dec;41(12):5268-5275.
doi: 10.1016/j.arthro.2025.07.029. Epub 2025 Jul 30.

Establishing the Minimum Clinically Important Difference, Patient Acceptable Symptomatic State, and Substantial Clinical Benefit After Isolated Medial Patellofemoral Ligament Reconstruction

Tristan J Elias  1 , Erik Haneberg  1 , Daniel J Kaplan  2 , Andrew Phillips  1 , Divesh Sachdev  1 , Nikhil Verma  1 , Jorge Chahla  1 , Brian Forsythe  1 , Brian J Cole  1 , Adam B Yanke  3
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Establishing the Minimum Clinically Important Difference, Patient Acceptable Symptomatic State, and Substantial Clinical Benefit After Isolated Medial Patellofemoral Ligament Reconstruction

Tristan J Elias et al. Arthroscopy. 2025 Dec.

Abstract

Purpose: To establish the minimum clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) for the Kujala score in patients who underwent isolated Medial patellofemoral ligament reconstruction (MPFLR) for patellar instability with a minimum 23 month follow-up.

Methods: This retrospective cohort study used a prospectively maintained database of patients undergoing primary MPFLR between April 2016 and June 2021. Patients with concomitant procedures, such as osteotomy, trochleoplasty, meniscus repair, other ligamentous reconstruction, and cartilage transplantation, were excluded. Kujala scores were recorded at baseline and minimum of 23 months postoperatively. Anchor-based and distribution-based methods were used to calculate the MCID, SCB, and PASS.

Results: A total of 107 patients (109 knees; 21.5 ± 9.1 years old, 26.0 ± 6.7, 68.2% female, 61.5% left side) with a minimum of 23 months follow-up patient-reported outcome measures were included in the final analysis. The Kujala score threshold for achieving the MCID was defined as an increase of 10.0 on the basis of the distribution-method calculations and 12.0 using anchor-based analysis. The SCB was defined as an increase of 25.5. The PASS was defined as achieving a minimum of 23 month Kujala score of 78.5. These results are comparable with scores seen at 6 months and 1 year. The MCID was calculated to be 86% sensitive and 64% specific; SCB was found to be 67% sensitive and 100% specific; and PASS was found to be 85% sensitive and 80% specific. The rates of achieving the MCID, SCB, and PASS at a minimum of 23 months were 89% (distribution)/84% (anchor), 58%, and 78%, respectively.

Conclusions: This study established thresholds for the MCID, SCB, and PASS at a minimum of 23 months after isolated MPFLR. The distribution-based MCID corresponded with an improvement in Kujala score or 10.0 as compared with the anchor-based method of 12.0. The value for achieving a SCB was 25.5. An absolute Kujala score of 78.5 was determined to be the threshold for patient satisfaction 23 months postoperatively.

Level of evidence: Level IV, retrospective case series.

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Conflict of interest statement

Disclosures All authors (T.J.E., E.H., D.J.K., A.P., D.S., N.V., J.C., B.F., B.J.C., A.B.Y.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.