Summary
Isolated MPFLR leads to similar anterior knee pain and similar redislocation rates in patients with TT-TG distances greater than 15mm, suggesting this procedure as a possible alternative to MPFLR combined with TTO in this patient population.
Abstract
Introduction
To determine the effect 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 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 15mm 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 in order 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 pooled redislocation rate in 19 studies examining isolated MPFLR procedures comprising 948 patients was 3.1% (95% CI 2.1%-4.4%, I2 = 7%) as opposed to 3.2% (95% CI 1.9%-5.0%, I2 = 0%) in 15 studies comprising 486 patients in the concomitant group. 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 return to sport rate in seven studies with 472 total patients in the isolated MPFLR group was 82% (95% CI 78%-86%, I2=16%) compared to a score of 92% (95% CI, 78%-99%, I2=58) in four studies comprising 54 patients in the concomitant group. There were similar complication rates between both treatment groups, including range of motion deficits, fractures, infections, and graft failures.
Conclusion
Isolated MPFLR leads to similar anterior knee pain, similar dislocation rates and lower return to sport rates than concomitant MPFLR and TTO procedures in patients with TT-TG distances greater than 15mm. Information from this review can aid surgeons in their decision to perform a concomitant TTO in patients with recurrent patellar instability and elevated TT-TG distances.