Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Dec 18;11(4):e70112.
doi: 10.1002/jeo2.70112. eCollection 2024 Oct.

Double-bundle versus single-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocation: A meta-analysis

Yiheng Wu  1 , Junran Li  2 , Hongbo Zhao  2 , Hongyan Zhou  2 , Bokai Wang  1 , Jinlong Zhang  1 , Shengkun Zhao  3
Affiliations
Review

Double-bundle versus single-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocation: A meta-analysis

Yiheng Wu et al. J Exp Orthop. .

Abstract

Purpose: To compare the clinical efficacy of single-bundle versus double-bundle reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar dislocation (RPD) regarding knee function scores, postoperative complications, and imaging assessments.

Methods: A computerized search of PubMed, Cochrane Library, Embase, China Biomedical Literature Database (CBM), China National Knowledge Network (CNKI), and VIP Database was performed for single-bundle versus double-bundle reconstruction of the medial patellofemoral ligament for treatment of RPD. Randomized controlled trials (RCTs) were evaluated for quality using the risk-of-bias evaluation tool recommended by the Cochrane Collaboration Network, and Cohort studies (CSs) were assessed using the Newcastle-Ottawa Scale (NOS) scale. Meta-analysis was performed using RevMan 5.3 software and STATA 16.0.

Results: Thirteen studies were included, four randomized controlled studies, and nine cohort studies. The level of evidence for the four randomized controlled studies was Ⅰ, and the nine cohort studies were Ⅲ. A total of 862 (891 knees) patients were included, of which 448 (465 knees) underwent double-bundle MPFL reconstruction and 414 (426 knees) underwent single-bundle MPFL reconstruction. Kujala score (MD = 2.06, 95% confidence interval [CI] [0.11, 4.01], p < 0.05), Tegner score (MD = 0.39, 95% CI [0.11, 0.68], p < 0.05), International Knee Documentation Committee (IKDC) score (MD = 4.88, 95% CI [1.46, 8.31], p < 0.05), and postoperative recurrence instability (odds ratio [OR] = 0.12, 95% CI [0.04, 0.44], p < 0.05) were better in the double-bundle group than in the single-bundle group. Lysholm score (MD = 0.86, 95% CI [-0.76, 2.48], p = n.s), patellar tilt angle (MD = -0.22, 95% CI [-0.54, 0.10], p = n.s), patellar lateral shift rate (MD = -0.16, 95% CI [-0.41, 0.09], p = n.s), congruence angle (MD = 0.06, 95% CI [-0.41, 0.52], p = n.s), postoperative knee pain (OR = 0.39, 95% CI [0.14, 1.11], p = n.s), and additional postoperative surgical treatment (OR = 0.20, 95% CI [0.01-6.25], p = n.s) had no statistically significant differences.

Conclusions: Double-bundle reconstruction of the medial patellofemoral ligament for RPD was superior to single-bundle reconstruction in both knee function scores and postoperative recurrent patellar instability, and double-bundle reconstruction of the medial patellofemoral ligament for RPD had better clinical outcomes.

Level of evidence: Level Ⅲ, Ⅰ and Ⅲ studies.

Keywords: double‐bundle; medial patellofemoral reconstruction; meta‐analysis; recurrent patellar dislocation; single‐bundle.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The flow chart of the study selection process.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Risk of bias graph. Red for high risk, green for low risk, and yellow for unclear risk of bias.
Figure 4
Figure 4
Forest plot of the comparison of the Kujala score between the double‐bundle (DB) and single‐bundle (SB).
Figure 5
Figure 5
Forest plot of the comparison of the Lysholm score between the double‐bundle (DB) and single‐bundle (SB).
Figure 6
Figure 6
Forest plot of the comparison of the Tegner score between the double‐bundle (DB) and single‐bundle (SB).
Figure 7
Figure 7
Forest plot of the comparison of the International Knee Documentation Committee (IKDC) score between the double‐bundle (DB) and single‐bundle (SB).
Figure 8
Figure 8
Forest plot of the comparison of the Patellar Tilt Angle (PTA) between the double‐bundle (DB) and single‐bundle (SB).
Figure 9
Figure 9
Forest plot of the comparison of the congruence angle (CA) between the double‐bundle (DB) and single‐bundle (SB).
Figure 10
Figure 10
Forest plot of the comparison of the patellar lateral shift rate (PLSR) between the double‐bundle (DB) and single‐bundle (SB).
Figure 11
Figure 11
Forest plot of the comparison of the postoperative instability between the double‐bundle (DB) and single‐bundle (SB).
Figure 12
Figure 12
Forest plot of the comparison of the postoperative pain in one knee between the double‐bundle (DB) and single‐bundle (SB).
Figure 13
Figure 13
Forest plot of the comparison of the additional postoperative surgical treatment between the double‐bundle (DB) and single‐bundle (SB).
Figure 14
Figure 14
Sensitivity analysis results. (a) Kujala score; (b) Lysholm score; (c) International Knee Documentation Committee (IKDC) score; (d) additional postoperative surgical interventions.
Figure 15
Figure 15
Funnel plots of the Kujala score.
Figure 16
Figure 16
The results of publication bias. (a) Egger's test; (b) Begg's test.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Arendt, E.A. , England, K. , Agel, J. & Tompkins, M.A. (2017) An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surgery, Sports Traumatology, Arthroscopy, 25, 3099–3107. Available from: 10.1007/s00167-016-4117-y - DOI - PubMed
    1. Askenberger, M. , Janarv, P.M. , Finnbogason, T. & Arendt, E.A. (2017) Morphology and anatomic patellar instability risk factors in first‐time traumatic lateral patellar dislocations: a prospective magnetic resonance imaging study in skeletally immature children. The American Journal of Sports Medicine, 45, 50–58. Available from: 10.1177/0363546516663498 - DOI - PubMed
    1. Astur, D.C. , Gouveia, G.B. , Borges, J.H.S. , Astur, N. , Arliani, G.G. , Kaleka, C.C. et al. (2015) Medial patellofemoral ligament reconstruction: a longitudinal study comparison of 2 techniques with 2 and 5‐years follow‐up. The Open Orthopaedics Journal, 9, 198–203. Available from: 10.2174/1874325001509010198 - DOI - PMC - PubMed
    1. Chen, J. , Li, Q. , Liu, S. , Fan, L. , Yin, B. , Yang, X. et al. (2022) Prediction of subsequent contralateral patellar dislocation after first‐time dislocation based on patellofemoral morphologies. Journal of Clinical Medicine, 12, 180. Available from: 10.3390/jcm12010180 - DOI - PMC - PubMed
    1. Duthon, V.B. (2015) Acute traumatic patellar dislocation. Orthopaedics & Traumatology: Surgery & Research, 101, S59–S67. Available from: 10.1016/j.otsr.2014.12.001 - DOI - PubMed