Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Bracing in Acute First-Time Traumatic Patellar Dislocation: A Systematic Review and Meta-Analysis

Abstract

Acute first-time traumatic patellar dislocation is a prevalent knee injury, particularly in adolescents, often managed conservatively with knee bracing. Recently, medial patellofemoral ligament (MPFL) reconstruction has gained popularity for its potential benefits in reducing redislocation rates and enhancing functional outcomes. This systematic review and meta-analysis compared the outcomes of MPFL reconstruction versus knee bracing for managing acute first-time traumatic patellar dislocation. A comprehensive search of PubMed, Scopus, Google Scholar, and the Cochrane Library identified studies published within the last 10 years that directly compared these treatment approaches, with primary outcomes focusing on redislocation rates and functional recovery measured by Kujala scores. A total of six studies, involving 325 patients, were included in the analysis. Results indicated that MPFL reconstruction significantly reduced redislocation rates (OR: 0.17, 95% CI: 0.09 to 0.32, P < 0.00001) and improved functional outcomes (MD in Kujala scores: 8.10, 95% CI: 6.46 to 9.75) compared to knee bracing. Despite notable heterogeneity across studies (I² = 95%), MPFL reconstruction consistently demonstrated superior long-term knee stability and fewer reoperations. These findings suggest that surgical intervention is the preferred treatment for long-term stability; however, further high-quality randomized controlled trials are recommended to confirm these results.

Keywords: acute; acute patellar dislocation; first-time patellar dislocation; knee brace; kujala score; lysholm score; mpfl; mpfl reconstruction; operative repair; traumatic patellar dislocation.

Figure 1. Example of a patella-stabilizing brace that can be used for recovery following a first-time dislocation.

Figure 2. Prisma flowchart of the reviewed studies.

PRISMA flow diagram illustrating the study selection process. A total of 180 records were identified from four databases (PubMed, Scopus, Google Scholar, and Cochrane Library). After removing 20 duplicate records, 160 unique records were screened. Of these, 120 were excluded during title and abstract screening for not directly comparing surgical versus conservative treatments or other irrelevant criteria. Forty full-text articles were reviewed, with 34 excluded for reasons such as lack of comparative data (n = 15), insufficient outcome reporting (n = 10), non-English language (n = 5), and non-relevant interventions or poor methodology (n = 4). Six studies were included in the final meta-analysis.

Figure 3. Forest plot of Kujala scores showing functional outcome differences between surgical and conservative treatments.

Data sourced from Refs. [8,19,20,23].

Figure 4. Funnel plot assessing publication bias for functional outcomes (Kujala scores) in the included studies.

MD, mean difference.

Figure 5. Forest plot comparing redislocation rates between MPFL reconstruction and knee bracing.

MPFL, medial patellofemoral ligament. Data sourced from Refs. [8,19-23].

Figure 6. Funnel plot assessing publication bias for redislocation rates in the included studies.