Medial patellofemoral ligament reconstruction in children

Matuszewski, Łukasz; Tramś, Marek; Ciszewski, Andrzej; Wilczyński, Michał; Tramś, Ewa; Jakubowski, Paweł; Matuszewska, Anna; John, Kishore

doi:10.1097/md.0000000000013605

Cited by 13 publications

(28 citation statements)

References 39 publications

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“…No further studies were found from manually checking the reference lists of the selected articles. In the end, 12 articles that met all the inclusion criteria were finalized for our study [9][10][11][12][13][14][15][16][17][18][19][20]. The flowchart in Figure 1 depicts the selection process of the studies.…”

Section: Search Resultsmentioning

confidence: 99%

Complications and Recurrence of Patellar Instability after Medial Patellofemoral Ligament Reconstruction in Children and Adolescents: A Systematic Review

et al. 2021

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Background: This study aimed to review the data available in the current literature concerning the complications and recurrence of instability following medial patellofemoral ligament (MPFL) reconstruction for patellar instability in young and adolescent patients (those <20 years old). Methods: A systematic review was performed based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two independent reviewers searched the PubMed, Scopus, EMBASE, and Cochrane databases. The terms “medial patellofemoral ligament” or “MPFL” and “reconstruction” and “young” or “adolescents” or “children” were used. The inclusion criteria for the literature review comprised studies that reported the complications and recurrences of instability in patients who had undergone MPFL reconstruction for patellar instability. Results: In all, 332 patients were included in the review, of which 195 were females (63.5%) and 112 were males (36.5%), and they totaled 352 treated knees. The mean age at the time of the surgery was 14.28 years, and the mean follow-up duration was 30.17 months. A total of 16 (4.5%) complications were reported: one (0.3%) patella fracture, one (0.3%) screw removal due to intolerance, one (0.3%) infection, five (1.4%) wound complications, six (1.7%) subluxations and two (0.6%) instances of post-operative stiffness. A total of 18 (5.1%) recurrences of patellar instability were recorded. Conclusions: MPFL reconstruction in young patients can be considered an effective and safe treatment leading to clinical improvement in terms of recurrence of dislocation. No major complications related to the technique were reported, but a high level of research evidence is required to better evaluate the clinical results in a long-term follow-up.

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Section: Search Resultsmentioning

confidence: 99%

Complications and Recurrence of Patellar Instability after Medial Patellofemoral Ligament Reconstruction in Children and Adolescents: A Systematic Review

et al. 2021

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“…Seven studies 4 , 7 , 8 , 14 , 16 , 23 , 24 met all criteria and were included in this systematic review ( Figure 1 ). The studies included 150 patients who underwent MPFLR with autograft and 193 with allograft ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies 4 , 16 randomized patients to receive autograft or allograft. Kumar et al 14 allowed patients and their families to make a choice between autograft or allograft after discussion of risks and benefits.…”

Section: Resultsmentioning

confidence: 99%

“…Table 3 shows the mCMS values from the 7 included studies. Four studies 7 , 14 , 16 , 24 received a good score, and 3 studies 4 , 8 , 23 received a poor score.…”

Section: Resultsmentioning

confidence: 99%

“…Risk of bias for the 6 nonrandomized 4 , 7 , 8 , 14 , 23 , 24 studies was assessed according to the Risk Of Bias In Non-randomized Studies–of Interventions (ROBINS-I 25 ) tool, which incorporates an assessment of bias due to confounding, selection of participants, deviations from intended interventions, completeness of outcome data, selection of outcomes reported, and other sources of bias. For the remaining randomized study, 16 risk of bias was assessed according to the Cochrane Collaboration risk-of-bias tool (Version 2). 9 The “template for completion” (provided at…”

Section: Methodsmentioning

confidence: 99%

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Autograft Versus Allograft for Medial Patellofemoral Ligament Reconstruction: A Systematic Review

Aliberti

Kraeutler

Miskimin

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Patients with recurrent lateral patellar dislocations are often treated with reconstruction of the medial patellofemoral ligament (MPFL). Purpose: To perform a systematic review to evaluate clinical outcomes and the risk of recurrent patellar dislocation after MPFL reconstruction (MPFLR) with autograft versus allograft. Study Design: Systematic review; Level of evidence, 4. Methods: The authors conducted a search of PubMed, the Cochrane Library, and Embase to identify studies comparing outcomes of MPFLR with autograft versus allograft. The inclusion criteria were full-text studies that directly compared clinical outcomes and/or risk of recurrent patellar instability between patients undergoing MPFLR with autograft versus allograft. A quality assessment was performed using the modified Coleman Methodology Score, and risk-of-bias assessment was performed using the Risk Of Bias In Non-randomized Studies–of Interventions and the Cochrane Collaboration tools. Results: Seven studies (1 evidence level 2, 3 level 3, 3 level 4) that met inclusion criteria were identified and included a total of 150 patients who underwent MPFLR with autograft and 193 with MPFLR with allograft. One study found a significantly higher failure rate among patients with autograft, and another study found a trend toward a significantly higher failure rate among patients with autograft. One study demonstrated no significant difference between postoperative tibial tubercle–trochlear groove distance (measured on magnetic resonance imaging scans) in failed versus successful grafts. One study found that patellar tilt angle improved significantly from preoperatively to postoperatively ( P < .001) but there was no difference between the groups. Kujala scores significantly improved for both autograft and allograft groups across studies. Two studies found significant differences in postoperative Kujala scores between the 2 groups, 1 of which found better scores in the allograft group ( P = .0032) and another in which scores were better in the autograft group ( P = .02). Conclusion: Patients undergoing MPFLR with either autograft or allograft can expect to experience improvement in clinical outcomes. Subjective outcomes improved to a similar degree in both groups. Graft failure was more frequently observed in patients with autograft. Allograft may be a better option for MPFLR owing to lower failure rate.

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Recurrent patellofemoral instability rates after MPFL reconstruction techniques are in the range of instability rates after other soft tissue realignment techniques

Wilkens¹,

Hannink²,

Groes³

2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Recurrent patellofemoral instability is a common knee injury in skeletally immature patients. Many surgical techniques have been described in the literature, all with different success rates. Purpose of this study was to perform a systematic review and meta-analysis of the available literature to assess recurrent patellofemoral instability rates after surgical treatment using MPFL reconstruction techniques and other soft tissue realignment techniques in skeletally immature patients. Methods PubMed, Embase, Web of Science, and The Cochrane Library were searched to identify all original articles concerning the surgical treatment for patellofemoral instability in skeletally immature patients and that reported post-operative recurrent patellofemoral instability rates. Subsequently a risk of bias assessment was conducted and a meta-analysis was performed on reported post-operative recurrent patellofemoral instability rates after MPFL reconstruction techniques and other soft tissue realignment techniques. Results Of the 21 eligible studies (448 knees in 389 patients), 10 studies reported on MPFL reconstruction techniques using different grafts and fixation techniques and 11 reported on other soft tissue realignment procedures. In total, 62 of the 448 (13.8%) treated knees showed recurrent patellofemoral instability during follow-up. The overall pooled recurrent patellofemoral instability rate was estimated to be 0.08 (95% CI 0.02-0.16). For MPFL reconstruction techniques, the pooled recurrent patellofemoral instability rate was estimated to be 0.02 (95% CI 0.00-0.09). For the other soft tissue realignment techniques, the pooled rate was estimated to be 0.15 (95% CI 0.04-0.31). No statistically significant difference in recurrent patellofemoral instability rates between MPFL reconstruction techniques and other soft tissue realignment techniques were found (n.s.). There was a large variation in treatment effects over different settings, including what effect is to be expected in future patients. Conclusion This systematic review and meta-analysis found that recurrent patellofemoral instability rates after MPFL reconstruction techniques are in the range of instability rates after other soft tissue realignment techniques. The clinical relevance of this study is that it provides clinicians with the best currently available evidence on recurrent patellofemoral instability rates after surgical treatment for patellofemoral instability in skeletally immature patients. Level of evidence IV.

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Medial patellofemoral ligament reconstruction in children

Cited by 13 publications

References 39 publications

Complications and Recurrence of Patellar Instability after Medial Patellofemoral Ligament Reconstruction in Children and Adolescents: A Systematic Review

Complications and Recurrence of Patellar Instability after Medial Patellofemoral Ligament Reconstruction in Children and Adolescents: A Systematic Review

Autograft Versus Allograft for Medial Patellofemoral Ligament Reconstruction: A Systematic Review

Recurrent patellofemoral instability rates after MPFL reconstruction techniques are in the range of instability rates after other soft tissue realignment techniques

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