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Meta-Analysis
. 2023 Oct:44:59-71.
doi: 10.1016/j.knee.2023.07.003. Epub 2023 Jul 31.

Isolated medial patellofemoral reconstruction outcomes: A systematic review and meta-analysis

Christopher Castagno  1 , Sterling Kneedler  2 , Austin Fares  3 , Michael Maier  4 , Gil Gontre  5 , William M Weiss  6
Affiliations
Meta-Analysis

Isolated medial patellofemoral reconstruction outcomes: A systematic review and meta-analysis

Christopher Castagno et al. Knee. 2023 Oct.

Abstract

Background: Treatment of patellar instability remains up for debate, and a combination of tibial tubercle osteotomy and medial patellofemoral ligament reconstruction (MPFLr) of the medial patellofemoral ligament (MPFL) has become the mainstay treatment for recurrent lateral patellar dislocation. Due to limited small studies, there remains a variety of surgical techniques still being practiced. The use of MPFL reconstruction, in isolation, has demonstrated promise.

Purpose: The purpose of this systematic review and meta-analysis is to investigate if isolated medial patellofemoral ligament reconstruction (iMPFLr) can safely and efficaciously restore knee stability and to present the patient demographics, surgical techniques, graft choices, clinical outcomes, and complications after iMPFLr for recurrent patellar dislocation (RPD).

Methods: A review of the current literature according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, yielded 299 abstracts. Twenty-seven articles met the inclusion/exclusion criteria accounting for 1200 patients. Data was pooled and analyzed focusing on patient demographics, graft type used, Kujala, International Knee Documentation Committee (IKDC), Lysholm, Tegner, and complications.

Results: Across all studies the weighted mean age was found to be an average of 24.5 years, BMI was 24.9 kg/m2, follow-up was 47.3 months, as 67% were female, TT-TG distance was 15.3 mm, and Caton Deschamps index 1.11. The pooled effect size difference of pre versus post assessment of Kujala was -2.8, IKDC was -4.5, Lysholm was -6.4, and Tegner was -0.74. The pooled complication rate was found to be 8% across all included studies. A subgroup analysis was also performed, specifically looking at how single bundle, double bundle, gracilis, semitendinosus and knee angle during fixation effect outcome data.

Conclusion: This systematic review and meta-analysis demonstrates that isolated MPFL reconstruction is a safe and effective treatment for recurrent patellar dislocations. Given the efficacy of isolated MPFL reconstruction, future investigations should aim to uncover the exact TT-TG distance, trochlear dysplasia, and patella alta grade for selecting patients to undergo this procedure. Furthermore, more primary research needs to be conducted on this topic due to the overall lack of published data from randomized controlled studies and no broad standardization of outcome measurements.

Level of evidence: (4) Systematic Review and Meta-Analysis.

Keywords: Isolated; MPFL; Medial patellofemoral ligament; Meta-analysis; Reconstruction; Systematic review.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors certify that they have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All authors contributed to the work. All research was performed at Texas Tech University Health Science Center El Paso Paul L Foster School of Medicine. The authors confirm contribution to the paper as follows: study conception and design: Christopher Castagno, Sterling Kneedler, Austin Fares; data collection: Sterling Kneedler, Austin Fares; analysis and interpretation of results: Christopher Castagno, Sterling Kneedler, Austin Fares, Michael Maier, Gilberto Gonzales, William Weiss; draft manuscript preparation: Christopher Castagno, Sterling Kneedler, Austin Fares, Michael Maier, Gilberto Gonzales, William Weiss. All authors reviewed the results and approved the final version of the manuscript. Additionally, the authors were provided statistical and computation help from Texas Tech University Health Science Center’s Statistics department and we would like to acknowledge their help with this project. There was no funding, grants, or awards needed to execute this project. The authors certify that the work has been IRB approved and performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA). All data relevant to the study are included in the article or uploaded as supplementary information.

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