Patellar fixation graft via suture anchors versus tunnel techniques during isolated MPFL reconstruction for recurrent patellofemoral instability: a systematic review of the literature

Abstract

Introduction There is still a lack of evidence concerning the patellar fixation of the medial patellofemoral ligament (MPFL) graft in selected patient with recurrent instability. The purpose of the present study was to investigate and compare clinical outcomes and further complications of isolated MPFL reconstruction via suture anchors versus tunnel techniques for recurrent patellofemoral instability. Materials and methods This systematic review of the literature was conducted according to the PRISMA guidelines. In September 2019, the main databases were accessed. All the clinical trials performing isolated MPFL reconstruction in patients with recurrent patellofemoral instability were included in the present study. Only articles fixing the MPFL graft through suture anchors and/ or patellar tunnel techniques were included in the analysis. Results Data from 46 papers (1712 patients) were recorded. The mean follow-up was 40 ± 18 months. No differences were found in Kujala, Lysholm and Tegner score, International Knee Documentation Committee, visual analogic scale, range of motion and re-dislocation rate. The suture anchors fixation group detected reduced rate of apprehension test (OR: 0.6; p = 0.03), revision surgeries (OR: 0.4; p = 0.02) and anterior knee pain (OR: 0.05; p < 0.0001) and reduced not-classified complications (OR: 0.18; p < 0.0001). Conclusion Both the suture anchors and the bone-tunnels are a feasible option for isolated MPFL reconstruction in patients with recurrent patellofemoral instability. Patellar fixation via suture anchors evidenced a reduced rate of anterior knee pain, revision surgeries, apprehension test and an overall reduced complication compared to the bone-tunnel technique.

Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective

“…The number of bundles, type of fixation, and graft tensioning for MPFL reconstruction in patients with patellofemoral instability is still debated [2,8,10,37,[52][53][54][55][56][57][58]. Thus, several variations and combinations of procedures have been described.…”

Management of Patellar Chondral Defects with Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures: A Four Years Follow-Up Clinical Trial

“…In patients with patellar chondral defects, pathoanatomical tissue morphology predisposing to patellofemoral instability (PFI) must be investigated [55,56]. Chondral defects are common in patients who experienced a patellar dislocation, [57][58][59][60][61][62]. Up to 96% of patients after patellar dislocation experience chondral damages [63][64][65][66].…”

Reconstrucción del ligamento patelofemoral medial mediante suturas transóseas patelares: estudio transversal de 34 pacientes

“…On the other hand, many authors have found more complications related to the use of patellar bone tunnels, especially patellar fractures, and persistent pain. 17,[20][21][22][23][24][25]38,39 Desai et al, 1 in their systematic review, showed rates of patellar fractures between 0% and 17%, significantly higher in bone tunnel techniques, despite the fact that the clinical outcomes are similar to those of cortical fixation techniques. The risk of fracture increases as the tunnel size increases, especially for those > 4.5 mm, as seen with EndoButton techniques.…”

“…12 Common patellar fixation techniques for MPFLR include anchors, bone tunnels, and interference screws. [16][17][18][19] Studies comparing fixation methods show a higher risk of patellar fracture in bone tunnel techniques. 17,[20][21][22][23][24][25] Transosseous sutures have been described also for MPFLR with single-bundle reconstruction, 26 but no clinical studies were found for double-bundle reconstruction.…”