Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis

Abstract

Background: Given the proximity of the medial patellofemoral ligament (MPFL) femoral insertion to the distal femoral physis in skeletally immature patients, multiple techniques for femoral graft fixation have been described. Purpose: To systematically review the literature and evaluate outcomes and complications following MPFL reconstruction in skeletally immature patients. Study Design: Systematic review; Level of evidence, 4. Methods: A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines through use of the PubMed, Embase, and Cochrane Central databases. All original, English-language studies reporting outcomes or complications following MPFL reconstruction in skeletally immature patients were included. Skeletally mature patients were excluded. Data regarding demographics, surgical technique, graft type, outcomes, and complications were recorded. Study quality was assessed by use of the modified Coleman methodology score. Statistical analysis was performed through use of chi-square and weighted mean pooled cohort statistics, where appropriate, with significance set at P < .05. Results: 7 studies that entailed 132 MPFL reconstructions (126 patients) met the inclusion criteria. Females comprised 57.9% of the cohort (73 females), and the mean age was 13.2 years (range, 6-17 years). Mean postoperative follow-up was 4.8 years (range, 1.4-10 years). All of the grafts used were autograft, with gracilis tendon (n = 80; 60.6%) being the most common. Methods of femoral fixation included interference screw (n = 52; 39.4%), suture anchor (n = 51; 38.6%), and soft tissue pulley around the medial collateral ligament or adductor tendon (n = 29; 21.9%). Pooled Kujala scores improved from 59.1 to 84.6 after MPFL reconstruction. The total reported complication rate was 25.0% (n = 33) and included 5 redislocations (3.8%) and 15 subluxation events (11.4%). No cases of premature physeal closure were noted, and there were 3 reports of donor site pain (2.3%). Neither autograft choice ( P > .804) nor method of femoral fixation ( P > .416) influenced recurrent instability or overall complication rates. Conclusion: These findings suggest that MPFL reconstruction in skeletally immature patients is a viable treatment option, with significant improvement in patient-reported outcomes and redislocation event rates of less than 5% at nearly 5-year follow-up. Further high-quality research is needed to determine optimal graft options and surgical technique while considering recurrent instability, donor site morbidity, and potential injury to the adjacent physis.

Efficacy Study of Medial Patellofemoral Ligament Single-bundle Reconstruction with Anterior Half of the Peroneus Longus Tendon Autograft for Treatment of Recurrent Patellar Dislocation

“…Furthermore, some studies [4,6] con rmed that the medial patellofemoral ligament of the knee can provide 50%~60% of the medial restraint of the patella exed at 0°~30°, and play a major role in maintaining patellar stability. Therefore, MPFL is the leading stable structure of medial patella, and MPFL reconstruction is increasingly focused on [7] .…”

Atualização em instabilidade patelar

“…45,46 A maioria dos estudos sobre a reconstrução do LPFM, isolada ou combinada a outras técnicas, mostram resultados positivos, com melhora da dor e da função física e baixa incidência de luxações recorrentes. Uma revisão sistemática 47 analisou os efeitos desta cirurgia em pacientes esqueleticamente imaturos (média 13,2 anos de idade e 4,8 anos de pósoperatório, enxerto autólogo de flexores). Houve melhora significativa do questionário Kujala de 59,1 para 84,6 pontos antes e após a cirurgia.…”

Medial Patellofemoral Complex Advancement for Recurrent Lateral Patellar Instability and Selective Acute Primary Patellar Dislocations

“…6 Concerns about violation of physis in skeletally immature patients and the need for physeal sparing techniques further add to the existing complexity. 7 Apart from technical issues, high complication rates of up to one in every four patient is a concern after MPFL-R. 8,9 Patella fracture is still a dreaded complication, and methods to avoid patella fractures continue to evolve with varying success. 10 Other complications of MPFL-R include knee stiffness (flexion-deficit) and patellofemoral arthritis/pain.…”

“…Variable rates of recurrent instability have been reported with MPFL reconstructions in pooled analyses. 8,11 Recent pooled evidence suggests that other medial soft tissue procedures may not be inferior to MPFL-R, especially with respect to recurrent instability rates. 9,12 Using an algorithm-based approach, similar results of MPFL-R and MPFL repair were found (level II evidence).…”

“…Variable rates of recurrent instability have been reported with MPFL reconstructions in pooled analyses. 8 , 11 …”