Isolated versus combined medial patellofemoral ligament reconstruction for lateral instability of the patella

Vincent Vg An; Brahman S Sivakumar; Kevin Phan; Brett A Fritsch; Doron Sher

doi:10.1177/2309499018820698

Isolated versus combined medial patellofemoral ligament reconstruction for lateral instability of the patella

J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499018820698. doi: 10.1177/2309499018820698.

Authors

Vincent Vg An¹, Brahman S Sivakumar², Kevin Phan¹, Brett A Fritsch³, Doron Sher⁴

Affiliations

¹ 1 Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
² 2 Department of Orthopaedics, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
³ 3 Department of Orthopaedics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
⁴ 4 Department of Orthopaedics, Concord Repatriation General Hospital, Concord, New South Wales, Australia.

PMID: 30798706
DOI: 10.1177/2309499018820698

Abstract

Introduction: Medial patellofemoral ligament reconstruction (MPFLR) is regularly combined with a tibial tuberosity transfer (TTT) in cases of recurrent patellar instability with underlying structural deformity. However, these indications for a TTT have recently come into question. This study aimed to assess the traditional indications by comparing the outcomes of isolated and combined MPFLR for the treatment of recurrent lateral patellar dislocation.

Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies were those which reported the outcomes of either isolated or combined or both MPFLR. Studies were required to report at least one of the following: redislocation rate, revision due to instability, or the Kujala score.

Results: We found no difference between isolated and combined MPFLR in terms of redislocation ( p = 0.48), revisions due to instability ( p = 0.36), positive apprehension tests ( p = 0.25), or the Kujala score ( p = 0.58). Combined reconstruction presented more complications compared to isolated procedures ( p = 0.05). Subgroup analysis revealed no significant difference between studies investigating isolated medial patellofemoral ligament reconstruction MPFLR performed in patients with normal tibial tuberosity-trochlear groove (TT-TG) distances only or in patients with both normal and elevated TT-TG distances.

Conclusions: According to the published data, there is no difference in outcomes between isolated and combined MPFLR. Underlying structural deformity did not demonstrate any significant effect on the success of the isolated MPFLR. Although there are definite indications for combined reconstruction, the current evidence suggests that our inclusion criteria may not be entirely correct. Further study is required to clarify and refine the true indications for combined MPFLR.

Level of evidence: III, meta-analysis of nonrandomized studies.

Keywords: knee; medial patellofemoral reconstruction; patella; recurrent instability.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Humans
Joint Instability / diagnosis
Joint Instability / etiology
Joint Instability / surgery*
Ligaments, Articular / surgery*
Orthopedic Procedures / methods*
Patella / diagnostic imaging
Patella / surgery*
Patellar Dislocation / complications
Patellar Dislocation / diagnosis
Patellar Dislocation / surgery*
Patellofemoral Joint / diagnostic imaging
Patellofemoral Joint / surgery*
Plastic Surgery Procedures / methods*