Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis

Abstract

Background: Medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, and nonoperative treatment are important treatments for patients with patellar dislocation. However, it is unclear which treatment leads to better outcomes. Purpose: To determine the efficacy and safety of the 3 treatments in the treatment of patellar dislocation and compare the effect of MPFL reconstruction with MPFL repair, MPFL reconstruction with nonoperative treatment, and MPFL repair with nonoperative treatment. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Web of Science, Cochrane Library, Embase, CNKI (China National Knowledge Infrastructure), and Wanfang databases were searched from inception to December 2020. Included were clinical studies that described the efficacy and safety of 2 of the 3 treatments, studies directly comparing the clinical effects of the 2 operative techniques, or studies comparing the effects of reconstruction or repair with nonoperative treatment. Two reviewers independently extracted data and assessed the quality of the included studies with the Cochrane risk-of-bias tools. The outcomes evaluated were postoperative redislocation rate, revision rate, complications, and Kujala score. We used traditional direct pairwise meta-analysis as well as network meta-analysis for comprehensive efficacy of all 3 treatment measures. Results: Twelve studies were included: 5 compared MPFL reconstruction with MPFL repair, 2 compared MPFL reconstruction with nonoperative treatment, and 5 compared MPFL repair with nonoperative treatment. The risk of bias was serious in 4, moderate in 4 and low in 4 articles. MPFL reconstruction led to significantly reduced redislocation and improved Kujala scores compared with MPFL repair and nonoperative treatment. MPFL repair led to reduced redislocation rates compared with nonoperative treatment but did not show an obvious benefit in primary dislocations. There was no significant difference among the 3 treatments in terms of revision rate and incidence of complications, although we found that treatment-related complications were least likely to occur in nonoperative treatment. Conclusion: The results of this review indicate that MPFL reconstruction decreases recurrent dislocation compared with MPFL repair or nonoperative treatment, but it has a higher possibility of complications. MPFL repair resulted in less postoperative redislocation than nonoperative treatment but did not show an obvious benefit in primary dislocation.

First case report on persistent patellar dislocation in haemophilia A patient with a factor VIII inhibitor

“…Current literature contains systematic reviews evaluating the effect of operative versus non-operative treatment mostly in acute dislocations. Generally, a higher recurrent dislocation rate is found in conservatively managed patients than in surgically treated groups 8 Smith et al reports 13% in operated vs 26% in non-operated patients. 9 Moiz et al reports pooled re-dislocations rate 31% for conservative treatment.…”

“…10 Evaluating chronic recurrent dislocations in systematic review and missing comparable cohorts for non-operative treatment Liu et al report five studies favouring MPFL reconstruction over MPFL repair. 8 In locked persistent dislocations the literature is limited to case reports where surgical treatment is inevitable to restore patellofemoral joint. We found one review of the literature about neglected chronic patellar dislocation in non-haemophiliac population.…”

All-arthroscopic Knee Patellofemoral Ligament Repair

“…The ideal treatment strategy, whether surgical or conservative, especially in the case of a first-time dislocation associated with an MPFL tear, is still a matter of debate. 4 Regarding the redislocation rate, it seems that MPFL reconstruction is the most effective procedure when compared with MPFL repair and conservative treatment 5 , 6 while it bears the highest risk of clinically significant complications such as femoral tunnel widening or MPFL over-tightening 7 , 8 and thus may be considered an over-treatment after a first-time patellar dislocation. In such cases, MPFL repair may represent a valid alternative because it shows a lower redislocation rate when compared with conservative treatment and the rate of procedure-related complications is low.…”

“…In such cases, MPFL repair may represent a valid alternative because it shows a lower redislocation rate when compared with conservative treatment and the rate of procedure-related complications is low. 5 , 9 …”

Excellent Clinical and Radiological Outcomes after both Open Flake Refixation and Autologous Chondrocyte Implantation following Acute Patella Dislocation and Concomitant Flake Fractures

“…The chondrocytes were then isolated and proliferated in vitro for 3-5 weeks before they were implanted into the defect zone in a second surgical procedure [25]. All patients suffered from patellofemoral instability and were treated with either reconstruction of the medial patellofemoral ligament (MPFL) using the gracilis tendon or refixation of the medial retinaculum (in younger patients with open growth plates) [16]. If flake refixation was performed, patella stabilization was conducted in the same surgery.…”