Recurrent patellar dislocations without untreated predisposing factors: MPFL reconstruction vs other medial soft tissue surgical techniques - A meta-analysis

Davide Previtali, Stamen Milev Roumenov, Gherardo Pagliazzi, Giuseppe Filardo, Stefano Zaffagnini, Christian Candrian

Research output: Contribution to journalArticle

Abstract

Purpose The aim of the present meta-analysis is to provide a direct comparison between MPFL reconstruction and the other medial patellofemoral soft tissue surgeries in the restoration of the medial patellar restraint after lateral patellar dislocations in the absence of untreated predisposing factors such as high grade trochlear dysplasia, knee malalignment, patella alta or high TT-TG distance. Methods PubMed, Cochrane-library, WebOfScience, and grey literature databases were searched to find all the relevant records. Study selection, data extraction and risk of bias assessment were performed following the Cochrane and PRISMA guidelines. Different techniques to treat lateral patellar dislocation in the absence of untreated predisposing factors were compared in terms of redislocation and complication rates, Kujala, Lysholm, IKDC, and Tegner scores at the short-term (3 years) and long-term (>3years) follow-ups through meta-analyses. Results Six studies involving 319 knees were included in the meta-analysis. The analyses of redislocation (0.7% vs 2.9%) and minor complication rates (12% vs 9%) showed no significant differences between MPFL reconstruction and other medial soft tissue surgeries. Significant differences favoring MPFL reconstruction were documented in Kujala and Lysholm scores at short-term (8.6 p<0.001; 10.9 p<0.001) and long-term follow-ups (6.3 p=0.02; 13.5 p<0.001). No significant differences were found in the analyses of IKDC (p=0.10) and Tegner scores (p=0.19). Level of evidence was low or very low. Conclusions MPFL reconstruction and medial patellofemoral soft tissue surgery procedures were both effective in restoring the medial restraining forces preventing redislocation, but MPFL reconstruction provided better functional outcomes both at short-term and long-term follow-ups. Thus, besides the treatment of predisposing factors, MPFL reconstruction seems to be, based on the results of this meta-analysis, a suitable strategy to restore the medial restraining function in the treatment of recurrent LPD.

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