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To minimize the risk of re\u2010dislocations, isolated MPFL\u2010R is recommended in patients with no significant trochlea dysplasia and tibial tuberosity trochlear groove distance\u2009&lt;\u200920\u00a0mm on computed tomography (CT). Incidentally, these criteria are the same that are used to identify first time LPD patients where conservative treatment is recommended. The purpose of this study was therefore to compare MPFL\u2010R with active rehabilitation for patients with recurrent LPD (RLPD) in absence of the above mentioned underlying anatomical high\u2010risk factors for further patellar dislocations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>RLPD\u2010patients aged 12\u201330 without underlying anatomical high\u2010risk factors for further LPD were randomized into treatment either with isolated MPFL\u2010R or active rehabilitation provided and instructed by a physiotherapist. All patients underwent diagnostic arthroscopy for concomitant problems. The main outcome measure was persistent patellar instability at 12\u00a0months. Knee function at baseline and 12\u00a0months was asses using the following patient reported outcomes measures (PROMS); KOOS, Kujala, Cincinnati knee rating, Lysholm score and Noyes sports activity rating scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2010 and 2019, 61 patients were included in the study (MPFL\u2010R, <jats:italic>N<\/jats:italic>\u2009=\u200930, Controls, <jats:italic>N<\/jats:italic>\u2009=\u200931). Persistent patellar instability at 12\u00a0months was reported by 13 (41.9%) controls, versus 2 (6.7%) in the MPFL\u2010group (RR 6.3 (95% CI 1.5\u201325.5). No statistically significant differences in activity level were found between the MPFL\u2010group and the Controls at neither baseline nor follow up. The patients with persistent instability at 12\u00a0months did not score significantly lower on any of the PROMs compared to their stable peers, regardless of study group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with recurrent patellar dislocations have a six\u2010fold increased risk of persistent patellar instability if treated with active rehabilitation alone, compared to MPFL\u2010R in combination with active rehabilitation, even in the absence of significant anatomical risk factors. Active rehabilitation of the knee without MPFL\u2010R improves patient reported knee function after one year, but does not protect against persistent patellar instability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>1.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-06934-3","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T13:03:01Z","timestamp":1648472581000},"page":"3428-3437","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Medial patellofemoral ligament reconstruction is superior to active rehabilitation in protecting against further patella dislocations"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7467-7757","authenticated-orcid":false,"given":"Truls Martin","family":"Straume\u2010N\u00e6sheim","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Clinic of Orthopaedic Surgery Akershus University Hospital 1478 L\u00f8renskog Norway"},{"name":"<!--<label>2<\/label>--> Oslo Sports Trauma Research Center, Department of Sports Medicine Norwegian School of Sport Sciences Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per\u2010Henrik","family":"Randsborg","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Clinic of Orthopaedic Surgery Akershus University Hospital 1478 L\u00f8renskog Norway"},{"name":"<!--<label>2<\/label>--> Oslo Sports Trauma Research Center, Department of Sports Medicine Norwegian School of Sport Sciences Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Rune","family":"Mikaelsen","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Clinic of Orthopaedic Surgery Akershus University Hospital 1478 L\u00f8renskog Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asbj\u00f8rn","family":"\u00c5r\u00f8en","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Clinic of Orthopaedic Surgery Akershus University Hospital 1478 L\u00f8renskog Norway"},{"name":"<!--<label>2<\/label>--> Oslo Sports Trauma Research Center, Department of Sports Medicine Norwegian School of Sport Sciences Oslo Norway"},{"name":"<!--<label>3<\/label>--> Institute of Clinical Medicine University of Oslo Campus Ahus Oslo 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September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 March 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None of the authors report any conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study protocol was approved by the Regional Committee of Medical and Health Research Ethics of South East Norway before initiation of the study (REC South East, reference 2009\/2148).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All patients and their legal guardians (if younger than 18\u00a0years) provided oral and written consent before inclusion. The study was registered at ClincialTrials.org (NCT02263807).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}