Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in recurrent patellar instability:A systematic review and meta-analysis

BACKGROUND The medial patellofemoral ligament(MPFL),along with the medial patellotibial ligament(MPTL)and medial patellomeniscal ligament,aid in the stabilization of the patellofemoral joint.Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter,this ligament is critical in maintaining joint stability.There have been few studies on the combined MPFL and MPTL reconstruction and its benefits.AIM To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability.METHODS By May 8,2022,four electronic databases were searched:Medline(PubMed),Scopus,Web of Science,and Google Scholar.General keywords such as"patellar instability,""patellar dislocation,""MPFL,""medial patellofemoral ligament,""MPTL,"and"medial patellotibial ligament"were co-searched to increase the sensitivity of the search.RESULTS The pooled effects of combined MPFL and MPTL reconstruction for Kujala score(12-mo followup)and Kujala score(24-mo follow-up)were positive and incremental,according to the findings of this meta-analysis.The mean difference between the Cincinnati scores was also positive,but not statistically significant.The combination of the two surgeries reduces pain.According to cumulative meta-analysis,the trend of pain reduction in various studies is declining over time.CONCLUSION The combined MPFL and MPTL reconstruction has good clinical results in knee function and,in addition to providing good control to maintain patellofemoral joint balance,the patient's pain level decreases over time,making it a valid surgical method for patella stabilization.

Interference screws vs.suture anchors for isolated medial patellofemoral ligament femoral fixation:A systematic review

Purpose:The present study aimed to systematically review and compare 2 femoral autograft fixation techniques,namely,interference screws and suture anchors,for isolated medial patellofemoral ligament reconstruction in patients with recurrent patellofemoral instability at mid-to long-term follow-up.Methods:A literature search was performed in September 2020.All studies reporting the outcomes of primary isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability were considered for inclusion.Only studies reporting the type of femoral autograft fixation under examination were considered.Studies reporting data from patients with elevated tibial tuberosity-tibial groove,patella alta,and/or Dejour’s trochlear dysplasia types C and D,were not included.Only articles reporting data with a minimum follow-up period of 18 months were considered.Results:Data from 19 studies(615 patients)were retrieved.The overall age was 24.4±6.7 years(mean±SD).The mean follow-up was 46.5±20.9 months.There were 76 patients in the anchor group and 539 in the screw group.Comparability was found with regard to age and follow-up duration between the 2 study groups.There was comparability between the Kujala,Lysholm,and Tegner scores at baseline.At the last follow-up,no worthy differences were found in terms of mean Kujala(+2.1%;p=0.04),Lysholm(+1.7%;p=0.05),and Tegner(+15.8%;p=0.05)scores.Although complications occurred almost exclusively in the screw cohort,no statistically significant difference was found.Conclusion:Femoral autograft fixation through interference screws or suture anchors report similar clinical scores and rate of apprehension test,persistent joint instability,re-dislocations,and revisions.These results must be interpreted within the limitations of the present study.