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.

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.

Purpose To determine the most optimal surgical technique for medial patellofemoral ligament reconstruction (MPFLR). Methods Three databases MEDLINE, PubMed, and EMBASE were searched from inception to December 13 th , 2022, for level I or II studies comparing MPFLR techniques. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on patient-reported outcome measures were recorded. Quality assessment was carried out using the MINORS and Cochrane Risk of Bias assessment tools. Certainty of evidence was carried out with the GRADE assessment tool. Results Ten studies comprising 723 patients (723 knees) were included in this review. The weighted mean diference in Kujala, Lysholm, and IKDC scores comparing single-and double-tunnel patellar drilling techniques was 2.66 (95% CI −1.05-6.37, p = 0.16, I 2 = 0%) with moderate certainty, 0.78 (95% CI −9.02-10.58, p = 0.88, I 2 = 87%) with low certainty, and 1.71 (95% CI −2.43-5.86, p = 0.42, I 2 = 0%) with low certainty, respectively. Double-suture anchor patellar ixation demonstrated greater Kujala scores than transpatellar ixation (87.1 ± 2.8 vs 84.0 ± 3.8, p < 0.001) with moderate certainty. Y-shaped graft patellar ixation demonstrated superior Kujala scores to C-shaped graft patellar ixation (95.9 ± 4.7 vs 91.3 ± 9.7, p = 0.001) with moderate certainty. Augmentation of femoral ixation with polyester sutures demonstrated superior Kujala scores (97.8 ± 6.4. vs 88.0 ± 6.3, p < 0.005) with low certainty. Four-stranded grafts demonstrated greater Kujala scores than two-stranded grafts (93.5 ± 2.6 vs 91.6 ± 3.5, p = 0.01) with low certainty. ConclusionThe optimal MPFLR surgical technique is likely to utilize a four-stranded graft using either endobutton, doublesuture anchor, or transosseous suture patellar ixation with polyester suture augmented interference screw femoral ixation. Orthopedic surgeons can consider employing such a technique to improve patient outcomes by conferring greater graft stability, strength, and function. Level of evidence Level II.