Purpose
To provide a direct comparison between medial patellofemoral ligament (MPFL) reconstruction
and the other medial patellofemoral soft-tissue surgeries in the restoration of the
medial patellar restraint after lateral patellar dislocations in the absence of untreated
predisposing factors such as high grade trochlear dysplasia, knee malalignment, patella
alta or high tibial tubercle-trochlear groove distance.
Methods
PubMed, Cochrane-library, Web of Science, and gray literature databases were searched
to find all the relevant records. Study selection, data extraction, and risk of bias
assessment were performed following the Cochrane and Preferred Reporting Items for
Systematic Reviews and Meta-analysis guidelines. Different techniques to treat lateral
patellar dislocation in the absence of untreated predisposing factors were compared
in terms of redislocation and complication rates, Kujala, Lysholm, International Knee
Documentation Committee, and Tegner scores at the short-term (3 years) and long-term
(>3 years) follow-up through meta-analyses.
Results
Six studies involving 319 knees were included in the meta-analysis. The analyses of
redislocation (0.7% vs 2.9%) and minor complication rates (12% vs 9%) showed no significant
differences between MPFL reconstruction and other medial soft-tissue surgeries. Significant
differences favoring MPFL reconstruction were documented in Kujala and Lysholm scores
at short-term (8.6, P< .001; 10.9, P < .001) and long-term follow-ups (6.3, P = .02; 13.5, P < .001). No significant differences were found in the analyses of International Knee
Documentation Committee (P = .10) and Tegner scores (P = .19). Level of evidence was low or very low.
Conclusions
MPFL reconstruction and medial patellofemoral soft-tissue surgery procedures were
both effective in restoring the medial restraining forces preventing redislocation,
but MPFL reconstruction provided better functional outcomes both at short-term and
long-term follow-up. Thus, besides the treatment of predisposing factors, MPFL reconstruction
seems to be, based on the results of this meta-analysis, a suitable strategy to restore
the medial restraining function in the treatment of recurrent LPD.
Level of Evidence
Level III (meta-analysis of randomized and nonrandomized comparative trials)
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Article info
Publication history
Published online: January 27, 2020
Accepted:
December 17,
2019
Received:
June 18,
2019
Footnotes
See commentary on page 1735
D.P. and S.R.M. have contributed equally to this article and share first authorship.
The authors report the following potential conflict of interest or source of funding: D.F. reports institutional support from Finceramica Faenza SPA, Fidia Farmaceutici SPA, CartiHeal (2009), Eon Medica, IGEA Clinical Biophysics, Zimmer Biomet, and Kensey Nash, outside the submitted work. S.Z. reports personal fees from I+ SRL, grants from Fidia Farmaceutici SPA, CartiHeal ltd, IGEA Clinical Biophysics, Zimmer Biomet, and Kensey Nash, outside the submitted work; in addition, he has a patent Springer with royalties paid. C.C. reports grants from Medacta International SA, Johnson & Johnson, Lima Corporate, Zimmer Biomet, and Oped AG, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Repair or Reconstruct? Addressing Medial Patellofemoral Ligament Insufficiency in the Absence of Morphologic AbnormalitiesArthroscopyVol. 36Issue 6
- PreviewThe role of medial patellofemoral ligament (MPFL) repair versus reconstruction in the treatment of patellar instability continues to undergo debate. Repair of the ligament can be technically less demanding with fewer risks of morbidity, whereas reconstruction carries concerns of graft malpositioning or over-tensioning as well as the risk of patellar fracture. Studies directly comparing the 2 procedures in the setting of recurrent patellar instability have consisted of small series or low levels of evidence that inevitably include patients with concurrent morphologic risk factors such as tuberosity malalignment or patella alta, which are known factors that can influence the biomechanical behavior of the MPFL.
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