Recurrent patellar dislocations with patellar cartilage defects: A pain in the knee?

PurposeThis study aimed to explore the efficacy of medial patellofemoral ligament (MPFL) repair versus nonoperative rehabilitation treatment on the rate of patellar redislocation and functional outcomes in skeletally mature patients with traumatic, first‐time patellar dislocations. Materials and methodsMEDLINE, PubMed and EMBASE were searched from database inception to May 2022 for studies examining the management options for acute first‐time patellar dislocations. This study was conducted in accordance with PRISMA and R‐AMSTAR guidelines. Data on redislocation rates, functional outcomes including the Kujala score for anterior knee pain, and complication rates were extracted. A meta‐analysis was used to pool the mean postoperative Kujala score and calculate the proportion of patients sustaining redislocations using a random effects model. Quality assessment of included studies was performed for all included studies using the MINORS and Detsky scores. ResultsThis review included a total of 25 studies and 1,361 patients. The pooled mean redislocation rate in 15 studies comprising 798 patients in the rehabilitation group was 30% (95% CI 25–36%, I2 = 65%). Moreover, the pooled mean redislocation rate in 10 studies comprising 170 patients undergoing MPFL repair was 7% (95% CI 3–12%, I2 = 30%). The pooled mean postoperative Kujala score in 8 studies comprising 396 patients in the rehabilitation group was 82.5 (95% CI 78.3–86.8, I2 = 91%), compared to a score of 88 (95% CI 87–90, I2 = 76%) in 3 studies comprising 94 patients in the repair group. Range of motion deficits was reported in 3.8% of 893 patients in the rehabilitation group and 2.0% of 205 patients in the repair group. ConclusionMPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferiority with respect to a range of motion deficits compared to nonoperative treatment for the management of acute first‐time patellar dislocations. Level of evidenceIV.

Section: Discussionsupporting

confidence: 77%

MPFL repair after acute first-time patellar dislocation results in lower redislocation rates and less knee pain compared to rehabilitation: a systematic review and meta-analysis

Blackman

Zakharia

et al. 2022

“…The low incidence of redislocation after MPFL reconstruction in our study supports the consideration of early reconstruction. Lowering the incidence of redislocation is important to lessen short‐ and long‐term sequelae of dislocations, such as increased severity of cartilage injury, risk of developing patellofemoral arthritis, and risk of osteochondral fracture [4, 8, 11, 27, 34, 36, 41]. This finding is consistent with recent studies which have demonstrated lower redislocation rates with MPFL reconstruction in the acute setting, with rates ranging from 0 to 9% [4, 16, 24, 28, 45].…”

Section: Discussionmentioning

confidence: 99%

MPFL reconstruction results in lower redislocation rates and higher functional outcomes than rehabilitation: a systematic review and meta-analysis

Cohen

Le²,

Zakharia³

et al. 2022

Purpose To determine the efect of early MPFL reconstruction versus rehabilitation on the rate of recurrent patellar dislocations and functional outcomes in skeletally mature patients with traumatic, irst-time patellar dislocation. Methods Three online databases MEDLINE, PubMed and EMBASE were searched from database inception (1946, 1966, and 1974, respectively) to August 20th, 2021 for literature addressing the management of patients sustaining acute irsttime patellar dislocations. Data on redislocation rates, functional outcomes using the Kujala score, and complication rates were recorded. A meta-analysis was used to pool the mean postoperative Kujala score, as well as calculate the proportion of patients sustaining redislocation episodes using a random efects model. Quality assessment of included studies was performed for all included studies using the MINORS and Detsky scores. Results A total of 19 studies and 1,165 patients were included in this review. The pooled mean redislocation rate in 14 studies comprising 734 patients in the rehabilitation group was 30% (95% CI 25-36%, I 2 = 67%). Moreover, the pooled mean redislocation rate in 5 studies comprising 318 patients undergoing early MPFL reconstruction was 7% (95% CI 2-17%, I 2 = 70%). The pooled mean postoperative Kujala anterior knee pain score in 7 studies comprising 332 patients in the rehabilitation group was 81 (95% CI 78-85, I 2 = 78%), compared to a score of 87 (95% CI 85-89, I 2 = 0%, Fig. 4) in 3 studies comprising 54 patients in the reconstruction group. Conclusion Management of acute irst-time patellar dislocations with MPFL reconstruction resulted in a lower rate of redislocation of 7% in the reconstruction group vs 30% in the rehabilitation group and a higher Kujala score compared to the rehabilitation group. The information this review provides will help surgeons guide their decision to choose early MPFL reconstruction versus rehabilitation when treating patients with irst-time patellar dislocations and may guide future studies on the topic. Level of evidence IV.

“…Lower redislocation rates are associated with less long‐term dislocation events and decreased cartilage injury severity, osteochondral fracture, and patellofemoral arthritis [2, 3, 6, 10, 34, 39, 43]. The rate of redislocation for both procedures were similar, and were lower compared to the majority of studies that highlighted isolated MPFLR or non‐isolated MPFLR procedures (TTO, lateral retinacular release, etc.).…”

Section: Discussionmentioning

confidence: 92%

Isolated medial patellofemoral ligament reconstruction results in similar postoperative outcomes as medial patellofemoral ligament reconstruction and tibial-tubercle osteotomy: a systematic review and meta-analysis

Vivekanantha

Kahlon

Cohen

et al. 2022

Purpose To determine the efect of isolated medial patellofemoral ligament reconstruction (MPFLR) versus concomitant MPFLR and tibial-tubercle osteotomy (TTO) on patient-reported functional outcomes, rate of patellar redislocation, and rate of return to sport in skeletally mature patients with recurrent patellar instability and lateralization as deined by elevated tibial-tubercle trochlear groove (TT-TG) distance. Methods Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 10th, 2022 for literature outlining the management of patients with TT-TG indices greater than 15 mm with either isolated MPFLR or concomitant MPFLR and TTO procedures. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on functional outcomes via the Kujala anterior knee pain score, redislocation rates, return to sport rates, and complications were recorded. The MINORS score was used for all studies to perform a quality assessment of included studies. Results A total of 31 studies comprising 1405 patients (1452 knees) were included in this review. The mean Kujala score in 13 studies comprising 848 total patients in the isolated MPFLR group was 85.0 (range 80.9-97.5) compared to a score of 83.7 (range 77.2-94.0) in 14 studies comprising 459 patients in the concomitant group. The mean pooled redislocation rate in 19 studies examining isolated MPFLR procedures comprising 948 patients was 3.1% (95% CI 2.1-4.4%, I 2 = 7%) as opposed to 3.2% (95% CI 1.9-5.0%, I 2 = 0%) in 15 studies comprising 486 patients in the concomitant group. The mean pooled return to sport rate in seven studies with 472 total patients in the isolated MPFLR group was 82% (95% CI 78-86%, I 2 = 16%) compared to a score of 92% (95% CI 78-99%, I 2 = 58%) in four studies comprising 54 patients in the concomitant group. There were similar complication rates between both treatment groups, including range of motion deicits, fractures, infections, and graft failures. Conclusion Isolated MPFLR leads to similar anterior knee pain, similar redislocation rates and lower return to sport rates than concomitant MPFLR and TTO procedures in patients with TT-TG distances greater than 15 mm. Information from this review can aid surgeons in their decision to choose MPFLR versus concomitant procedures for this patient population, and can also guide future studies on this topic. Level of evidence Level IV.