Complication Rates After Medial Patellofemoral Ligament Reconstruction Range From 0% to 32% With 0% to 11% Recurrent Instability: A Systematic Review

Jackson, Garrett R.; Tuthill, Trevor; Gopinatth, Varun; Mameri, Enzo S.; Jawanda, Harkirat; Sugrañes, Joan; Asif, Shaan; Wessels, Morgan; McCormick, Johnathon R.; Kaplan, Daniel J.; Yanke, Adam B.; Knapik, Derrick M.; Verma, Nikhil N.; Chahla, Jorge

doi:10.1016/j.arthro.2023.01.098

Cited by 20 publications

(11 citation statements)

References 48 publications

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“…Only one patient in our series developed a large rebound valgus deformity after hardware removal. Another notable complication following MPFL reconstruction is recurrent PFI, with recurrence typically of 1%-11% [16,33], but up to 45% [31]. Only one extremity (4%) in our series had subsequent instability with recurrent patellar dislocations and necessitated MPFL revision and concomitant tibial tubercle osteotomy, in line with past literature.…”

Section: Discussionsupporting

confidence: 86%

Simultaneous MPFL reconstruction and guided growth result in low rates of recurrent patellofemoral instability

Bram,

Tracey,

Lijesen

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeImplant‐mediated guided growth (IMGG) is used to address coronal plane deformity in skeletally immature patients. Few studies have reported on IMGG and simultaneous medial patellofemoral ligament (MPFL) reconstruction for paediatric patients with concurrent genu valgum and patellofemoral instability (PFI). This study aimed to report on the outcomes of these simultaneous procedures.Materials and MethodsThis was a retrospective review of paediatric patients undergoing simultaneous MPFL reconstruction and IMGG between 2016 and 2023. Mechanical lateral distal femoral angle (mLDFA), hip–knee–ankle angle (HKA) and mechanical axis deviation (MAD) were measured on full‐length hip‐to‐ankle plain radiographs. Measurements were taken preoperatively, prior to implant removal and/or at final follow‐up with minimum 1‐year clinical follow‐up.ResultsA total of 25 extremities in 22 patients (10 female) underwent simultaneous IMGG and MPFL reconstruction. The mean age at surgery was 12.6 ± 1.7 years. The mean duration of implant retention was 18.6 ± 11.3 months. Nineteen extremities (76%) underwent implant removal by final follow‐up. Preoperative HKA corrected from a mean of 5.8 ± 2.3° to −0.8 ± 4.5° at implant removal or final follow‐up (p < 0.001), with mLDFA and MAD similarly improving (both p < 0.001). HKA corrected a mean of 0.7 ± 0.9° per month, while mLDFA and MAD corrected a mean of 0.5 ± 0.6°/month and 2 ± 3 mm/month, respectively. At the time of implant removal or final follow‐up, 88% of patients demonstrated alignment within 5° of neutral. Only one extremity experienced subsequent PFI (4%). For 14 patients who underwent implant removal with further imaging at a mean of 7.8 ± 4.9 months, only one patient (7%) had a valgus rebound to an HKA > 5°.ConclusionSimultaneous MPFL reconstruction and IMGG provided successful correction of lower extremity malalignment with only one recurrence of PFI. This approach is a reliable surgical option for skeletally immature patients with genu valgum and PFI.Level of EvidenceLevel 4 case series.

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Section: Discussionsupporting

confidence: 86%

Simultaneous MPFL reconstruction and guided growth result in low rates of recurrent patellofemoral instability

Bram,

Tracey,

Lijesen

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…The possible complications of this procedure are the same as those described for MPFL reconstruction, such as overtightening of the graft, leading to persistent anterior knee pain or knee stiffness, patellar fractures, failure, 32 and patellofemoral arthritis. 36 In our series, 19 we have the reported outcomes of 50 patients with a mean follow-up of 8.9 years (minimum 6 years), with a recurrence rate of dislocation of 12% and subjective instability complaint without dislocation in 6% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…For patellar fixation, unlike the use of free grafts, such as the gracilis tendon, the use of patellar or quadriceps tendons grafts does not require implants for graft fixation, which has the advantage of reducing costs and minimizing the risk of patellar fractures ( Table 2 ). 32 …”

Section: Discussionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction Using the Medial Third of the Patellar Tendon: Camanho’s Technique

Camanho,

Gobbi,

Helito

et al. 2024

Arthroscopy Techniques

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“…Medial patellofemoral ligament (MPFL) reconstruction (MPFL-R) has long been a mainstay in the surgical treatment of recurrent patellar dislocation (RPD) with a low redislocation rate [1]. However, there is increasing evidence that particular bony deformities, such as increased tibial tuberosity-trochlear groove (TT-TG) distance, patella alta, trochlear dysplasia and axial torsion of the lower extremity frequently occur in RPD patients and could compromise clinical outcomes of MPFL-R [2,3].…”

Section: Introductionmentioning

confidence: 99%

Derotational distal femoral osteotomy improves subjective function and patellar tracking after medial patellofemoral ligament reconstruction in recurrent patellar dislocation patients with increased femoral anteversion: A systematic review and meta‐analysis

Wang,

Zheng,

Cao

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study is to systematically review and quantitatively analyse the clinical outcomes of combined derotational distal femoral osteotomy (D‐DFO) and medial patellofemoral ligament reconstruction (MPFL‐R) in the treatment of recurrent patellar dislocation (RPD) with increased femoral anteversion angle (FAA).MethodsThis study was performed in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) and AMSTAR (Assessing the Methodological Quality Of Systematic Reviews) Guidelines. PubMed, Embase, Web of Science and Cochrane Library databases were searched to identify studies reporting clinical outcomes of combined D‐DFO and MPFL‐R in RPD patients with increased FAA. Data on patient‐reported outcome measures, radiological parameters, patellar tracking as revealed by J‐sign and complications were extracted based on the inclusion criteria. The Methodological Index for Non‐Randomized Study score was used for quality assessment. Review Manager and R statistical software were used to perform the statistical analysis.ResultsEleven studies with a total of 569 knees in 553 patients were included. Patients were predominantly female (79%). The weighted mean of FAA decreased from 33.6° to 13.0° (weighted mean difference = 20.59; p < 0.00001) after the combined procedure. Significant improvements (p < 0.00001) were identified in the Lysholm score (weighted mean: 55.5 vs. 80.4), International Knee Documentation Committee (IKDC) score (weighted mean: 52.8 vs. 78.6) and Kujala score (weighted mean: 54.5 vs. 80.6). The incidence of residual J‐sign ranged from 14.3% to 38.3% with an overall pooled rate of 28.2% (95% confidence interval = 22.8%–33.6%). The overall redislocation rate was 1.1%. No patients experienced surgical site infection or bone nonunion. Two studies compared the clinical outcomes of MPFL‐R with and without D‐DFO. Compared with isolated MPFL‐R, the combined procedure yielded a better Lysholm score (weighted mean: 84.9 vs. 79.3, p < 0.0001), IKDC score (weighted mean: 84.1 vs. 79.9, p = 0.001), Kujala score (weighted mean: 84.3 vs. 79.4, p < 0.0001) and a lower residual J‐sign rate (26/97 [26.8%] vs. 44/105 [41.9%], p = 0.02), respectively.ConclusionThe combination of D‐DFO and MPFL‐R led to improved clinical outcomes and a low redislocation rate in patients with RPD and increased FAA. Additional D‐DFO can achieve more favourable results in subjective function and patellar tracking than isolated MPFL‐R in the setting of excessive FAA.Level of Evidence: Level IV.

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Complication Rates After Medial Patellofemoral Ligament Reconstruction Range From 0% to 32% With 0% to 11% Recurrent Instability: A Systematic Review

Cited by 20 publications

References 48 publications

Simultaneous MPFL reconstruction and guided growth result in low rates of recurrent patellofemoral instability

Simultaneous MPFL reconstruction and guided growth result in low rates of recurrent patellofemoral instability

Medial Patellofemoral Ligament Reconstruction Using the Medial Third of the Patellar Tendon: Camanho’s Technique

Derotational distal femoral osteotomy improves subjective function and patellar tracking after medial patellofemoral ligament reconstruction in recurrent patellar dislocation patients with increased femoral anteversion: A systematic review and meta‐analysis

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