Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective

Abstract

Purpose This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on patient-reported outcome measures (PROMs), redislocation rate, and complications. The hypothesis was that hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective. Methods This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library databases were accessed in October 2021. All the clinical studies investigating the efficacy and feasibility of hardware-free MPFL reconstruction were screened for inclusion. Only studies with a minimum 24-month follow-up were considered eligible. Kujala Anterior Knee Pain Scale improvement and redislocation rate after surgical treatment were evaluated as primary outcomes. The rate of postoperative complications was evaluated as a secondary outcome. The quality of the methodological assessment was assessed using the Modified Coleman Methodology Score. Results Eight studies were included in the present systematic review. The quality of the methodological assessment was moderate. Short- to long-term improvement of Kujala score was observed in all included studies. Mean score improvement ranged from + 13.2/100 to + 54/100, with mean postoperative scores ranging from 82/100 to 94/100. Patellar redislocation was observed in 8.33% (8 of 96) patients. Conclusion Hardware-free MPFL reconstruction with or without associated soft-tissue or bony realignment procedures provided reliable clinical improvements and was associated with a low rate of redislocation in patients with recurrent patellofemoral instability. Advantages such as safety, femoral physis preservation, and comparable complication profiles with implant-based techniques endorse its implementation. Orthopedic surgeons in cost-sensitive environments may also benefit their patients with lower costs, no need for implants, lack of implant-related complications, or surgery for implant removal. Level of evidence: Level IV.

Quality of life following medial patellofemoral ligament reconstruction combined with medial tibial tubercle transfer in patients with recurrent patellar dislocation: a retrospective comparative study

“…The MPFL is the primary static soft tissue restraint which restrains against lateral subluxation and dislocation of the patella, especially between 0° and 30° of knee flexion [ 9 ]. Therefore, injury or deficiency of MPFL is one of the predisposing factors for RPD.…”

“…Patellar stability depends on the bony structure of patella and femoral trochlea, restraint of soft tissues, lower limb alignment and coordination of muscles around the knee [5]. The etiology of RPD is multifactorial, including medial patellofemoral ligament (MPFL) injuries, abnormally lateralized tibial tubercle (TT), femoral trochlear dysplasia, patella alta, Wiberg type C patella, increased femoral anteversion and genu valgum [6][7][8][9][10].…”

“…Therefore, an anatomical repair MPFL is necessary to prevent redislocation of patella [11]. Although various procedures have been reported for the treatment of RPD, MPFL reconstruction (MPFLr), which is one of the proximal realignment surgical techniques, has become an increasingly common and popular procedure in the last decade, with satisfactory clinical outcomes, reduced redislocation rates and improved quality of life (QoL) although surgical techniques and graft types are various [5,8,9,[12][13][14]. However, it is necessary to consider the potential risk factors before isolated MPFLr (iMPFLr) [15][16][17].…”

Quality of life following medial patellofemoral ligament reconstruction combined with medial tibial tubercle transfer in patients with recurrent patellar dislocation: a retrospective comparative study

“…The MPFL is the primary static soft tissue restraint which restrains against lateral subluxation and dislocation of the patella, especially between 0° and 30° of knee exion [9]. Therefore, injury or de ciency of MPFL is one of the predisposing factors for RPD.…”

“…In most cases, an acute traumatic patellar dislocation leads to MPFL rupture [8]. Although various procedures have been reported for the treatment of RPD, MPFL reconstruction (MPFLr), which is one of the proximal realignment surgical techniques, has become an increasingly common and popular procedure in the last decade, with satisfactory clinical outcomes, reduced redislocation rates and improved quality of life (QoL) although surgical techniques and graft types are various [5,[8][9][10][11][12]. However, it is necessary to consider the potential risk factors before isolated MPFLr (iMPFLr) [13][14][15].…”