Skip to main content

Advertisement

SpringerLink
Log in

Medial patellofemoral ligament reconstruction using patella bone tunnel techniques with or without implants. A systematic review of outcomes and complications

  • General Review
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Τhe main goal of this study was to compare the clinical results, including the complication rates and patient-reported outcomes, in patients who underwent surgery for recurrent patellar dislocation using different patellar tunnel fixation techniques. This study compared Medial Patellofemoral Ligament (MPFL) reconstruction implant free techniques against ones that used implants.

Methods

The present systematic review was conducted according to the PRISMA guidelines. The literature search was conducted in January 2023. We included patients who underwent isolated MPFL reconstruction for recurrent patellar instability. Patients with confirmed concomitant or prior ipsilateral knee procedures, multiligament injury, severe patellar dysplasia or less than 6 months of follow-up were excluded. MINORS and MCMS scores were used for the assessment of methodological quality.

Results

Data from 750 procedures were collected, of which 284 used implants to perform the procedure while in 455 an implant-free technique was used. Patient age at the time of surgery ranged from 11 to 60 years while the follow-up time of the studies ranged between 3 and 108 months. Postoperative Kujala (0.3, p = 0.89) and Lysholm (1.2, p = 0.26) scores were better in the implant-free techniques compared to implant-based. A higher rate of recurrent dislocation (OR 0.51; 95% CI 0.10–2.54, p = 0.4), subluxation (OR 0.20; 95% CI 0.40–0.88, p = 0.019) and stiffness (OR 0.76; 95% CI 0.33–1.72, p = 0.55) was noted in the implant-free techniques, while the implant-based techniques displayed increased incidence of patella fractures (OR 3.12; 95% CI 0.77–12.6, p = 0.09), reoperation (OR 1.69; 95% CI 0.78–3.65, p = 0.17) and infection (OR 2.07; 95% CI 0.46–9.32, p = 0.33).

Conclusion

There was no significant difference between the 2 techniques in terms of patient reported outcomes. Regarding complications, MPFL reconstruction using implants demonstrated significant higher rate of patella fractures while the implant free technique showed a greater risk of subluxation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mitchell J, Magnussen RA, Collins CL, Currie DW, Best TM, Comstock RD et al (2015) Epidemiology of patellofemoral instability injuries among high school athletes in the United States. Am J Sports Med 43:1676–1682. https://doi.org/10.1177/0363546515577786

    Article  PubMed  Google Scholar 

  2. Koh JL, Stewart C (2015) Patellar instability. Orthop Clin North Am 46:147–157. https://doi.org/10.1016/j.ocl.2014.09.011

    Article  PubMed  Google Scholar 

  3. Panni AS, Vasso M, Cerciello S (2013) Acute patellar dislocation. What to do? Knee Surg Sports Traumatol Arthrosc 21:275–278. https://doi.org/10.1007/s00167-012-2347-1

    Article  PubMed  Google Scholar 

  4. Krebs C, Tranovich M, Andrews K, Ebraheim N (2018) The medial patellofemoral ligament: review of the literature. J Orthop 15:596–599. https://doi.org/10.1016/j.jor.2018.05.004

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lee D-Y, Park Y-J, Song S-Y, Hwang S-C, Park J-S, Kang D-G (2018) Which technique is better for treating patellar dislocation? A systematic review and meta-analysis. Arthroscopy 34:3082-3093.e1. https://doi.org/10.1016/j.arthro.2018.06.052

    Article  PubMed  Google Scholar 

  6. Chouteau J (2016) Surgical reconstruction of the medial patellofemoral ligament. Orthop Traumatol Surg Res 102:S189-194. https://doi.org/10.1016/j.otsr.2015.06.030

    Article  CAS  PubMed  Google Scholar 

  7. Desai VS, Tagliero AJ, Parkes CW, Camp CL, Cummings NM, Stuart MJ et al (2019) Systematic review of medial patellofemoral ligament reconstruction techniques: comparison of patellar bone socket and cortical surface fixation techniques. Arthroscopy 35:1618–1628. https://doi.org/10.1016/j.arthro.2018.10.150

    Article  PubMed  Google Scholar 

  8. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. https://doi.org/10.1136/bmj.b2700

    Article  PubMed  PubMed Central  Google Scholar 

  9. Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian institute of sport tendon study group. Scand J Med Sci Sports 10:2–11. https://doi.org/10.1034/j.1600-0838.2000.010001002.x

    Article  CAS  PubMed  Google Scholar 

  10. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  11. Malatray M, Magnussen R, Lustig S, Servien E (2019) Lateral retinacular release is not recommended in association to MPFL reconstruction in recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 27:2659–2664. https://doi.org/10.1007/s00167-018-5294-7

    Article  PubMed  Google Scholar 

  12. Panni AS, Alam M, Cerciello S, Vasso M, Maffulli N (2011) Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med 39:2647–2655. https://doi.org/10.1177/0363546511420079

    Article  PubMed  Google Scholar 

  13. von Engelhardt LV, Fuchs T, Weskamp P, Jerosch J (2018) Effective patellofemoral joint stabilization and low complication rates using a hardware-free MPFL reconstruction technique with an intra-operative adjustment of the graft tension. Knee Surg Sports Traumatol Arthrosc 26:2750–2757. https://doi.org/10.1007/s00167-017-4723-3

    Article  Google Scholar 

  14. Zhou J-W, Wang C-H, Ji G, Ma L-F, Wang J, Zhang F et al (2014) A minimally invasive medial patellofemoral ligament arthroscopic reconstruction. Eur J Orthop Surg Traumatol 24:225–230. https://doi.org/10.1007/s00590-012-1162-1

    Article  PubMed  Google Scholar 

  15. Ercan N, Akmese R, Ulusoy B (2021) Single-tunnel and double-tunnel medial patellofemoral ligament reconstructions have similar clinical, radiological and functional results. Knee Surg Sports Traumatol Arthrosc 29:1904–1912. https://doi.org/10.1007/s00167-020-06260-6

    Article  PubMed  Google Scholar 

  16. Panagopoulos A, van Niekerk L, Triantafillopoulos IK (2008) MPFL reconstruction for recurrent patella dislocation: a new surgical technique and review of the literature. Int J Sports Med 29:359–365. https://doi.org/10.1055/s-2007-965360

    Article  CAS  PubMed  Google Scholar 

  17. Mulliez A, Lambrecht D, Verbruggen D, Van Der Straeten C, Verdonk P, Victor J (2017) Clinical outcome in MPFL reconstruction with and without tuberositas transposition. Knee Surg Sports Traumatol Arthrosc 25:2708–2714. https://doi.org/10.1007/s00167-015-3654-0

    Article  CAS  PubMed  Google Scholar 

  18. Lee PYF, Golding D, Rozewicz S, Chandratreya A (2018) Modern synthetic material is a safe and effective alternative for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:2716–2721. https://doi.org/10.1007/s00167-017-4711-7

    Article  PubMed  Google Scholar 

  19. Astur DC, Gouveia GB, de Borges JH, Astur N, Arliani GG, Kaleka CC et al (2015) Medial patellofemoral ligament reconstruction: a longitudinal study comparison of 2 techniques with 2 and 5 years follow-up. Open Orthop J 9:198–203. https://doi.org/10.2174/1874325001509010198

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kita K, Horibe S, Toritsuka Y, Nakamura N, Tanaka Y, Yonetani Y et al (2012) Effects of medial patellofemoral ligament reconstruction on patellar tracking. Knee Surg Sports Traumatol Arthrosc 20:829–837. https://doi.org/10.1007/s00167-011-1609-7

    Article  PubMed  Google Scholar 

  21. Kita K, Tanaka Y, Toritsuka Y, Amano H, Uchida R, Takao R et al (2015) Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis. Am J Sports Med 43:2988–2996. https://doi.org/10.1177/0363546515606102

    Article  PubMed  Google Scholar 

  22. Gonçaives MBJ, de Júnior LH, Soares LFM, Gonçaives TJ, Dos Santos RL, Pereira ML (2011) Medial patellofemoral ligament reconstruction to treat recurrent patellar dislocation. Rev Bras Ortop 46:160–164. https://doi.org/10.1016/S2255-4971(15)30233-0

    Article  PubMed  Google Scholar 

  23. Krishna Kumar M, Renganathan S, Joseph CJ, Easwar T, Rajan DV (2014) Medial patellofemoral ligament reconstruction in patellar instability. Indian J Orthop 48:501–505. https://doi.org/10.4103/0019-5413.139864

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yoon KH, Kim EJ, Kwon YB, Hwang IU, Kim S-G (2020) Comparison of clinical and radiological outcomes between transosseous tunnel and suture anchor patellar fixation for medial patellofemoral ligament reconstruction: a cohort study with 2 year follow-up. Orthop J Sports Med 8:2325967120917660. https://doi.org/10.1177/2325967120917660

    Article  PubMed  PubMed Central  Google Scholar 

  25. Devgan A, Yadav U, Sharma P, Rohilla R, Devgan R, Mudgil P et al (2019) Implantless patellar fixation in medial patellofemoral ligament reconstruction. Chin J Traumatol 22:281–285. https://doi.org/10.1016/j.cjtee.2019.06.001

    Article  PubMed  PubMed Central  Google Scholar 

  26. Csintalan RP, Latt LD, Fornalski S, Raiszadeh K, Inacio MC, Fithian DC (2014) Medial patellofemoral ligament (MPFL) reconstruction for the treatment of patellofemoral instability. J Knee Surg 27:139–146. https://doi.org/10.1055/s-0033-1360652

    Article  PubMed  Google Scholar 

  27. Li J, Li Z, Wang K, Liu C, Wang Y, Wang H (2019) Medial patellofemoral ligament reconstruction: a comparison of single-bundle transpatellar tunnel and double-anchor anatomic techniques for the treatment of recurrent lateral patellar dislocation in adults. Arthroscopy 35:845-854.e1. https://doi.org/10.1016/j.arthro.2018.08.050

    Article  PubMed  Google Scholar 

  28. Lind M, Enderlein D, Nielsen T, Christiansen SE, Faunø P (2016) Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc 24:666–671. https://doi.org/10.1007/s00167-014-3439-x

    Article  PubMed  Google Scholar 

  29. Matthews JJ, Schranz P (2010) Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop 34:1321–1325. https://doi.org/10.1007/s00264-009-0918-7

    Article  PubMed  Google Scholar 

  30. Niu Y, Wang X, Liu C, Wang X, Dong Z, Niu J et al (2018) Double-bundle anatomical medial patellofemoral ligament reconstruction with lateral retinaculum plasty can lead to good outcomes in patients with patellar dislocation. Knee Surg Sports Traumatol Arthrosc 26:2743–2749. https://doi.org/10.1007/s00167-017-4720-6

    Article  PubMed  Google Scholar 

  31. Paxton EW, Fithian DC, Stone ML, Silva P (2003) The reliability and validity of knee-specific and general health instruments in assessing acute patellar dislocation outcomes. Am J Sports Med 31:487–492. https://doi.org/10.1177/03635465030310040201

    Article  PubMed  Google Scholar 

  32. Schneider DK, Grawe B, Magnussen RA, Ceasar A, Parikh SN, Wall EJ et al (2016) Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations: a systematic review and meta-analysis. Am J Sports Med 44:2993–3005. https://doi.org/10.1177/0363546515624673

    Article  PubMed  PubMed Central  Google Scholar 

  33. Heo J-W, Ro K-H, Lee D-H (2019) Patellar redislocation rates and clinical outcomes after medial patellofemoral ligament reconstruction: suture anchor versus double transpatellar tunnel fixation. Am J Sports Med 47:1254–1262. https://doi.org/10.1177/0363546518765458

    Article  PubMed  Google Scholar 

  34. Parikh SN, Nathan ST, Wall EJ, Eismann EA (2013) Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med 41:1030–1038. https://doi.org/10.1177/0363546513482085

    Article  PubMed  Google Scholar 

  35. Parikh SN, Wall EJ (2011) Patellar fracture after medial patellofemoral ligament surgery: a report of five cases. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.J.01558

    Article  PubMed  Google Scholar 

  36. Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40:1916–1923. https://doi.org/10.1177/0363546512442330

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tompkins M, Arendt EA (2012) Complications in patellofemoral surgery. Sports Med Arthrosc Rev 20:187–193. https://doi.org/10.1097/JSA.0b013e31825c74cf

    Article  PubMed  Google Scholar 

  38. Erickson BJ, Mascarenhas R, Sayegh ET, Saltzman B, Verma NN, Bush-Joseph CA et al (2015) Does operative treatment of first-time patellar dislocations lead to increased patellofemoral stability? A systematic review of overlapping meta-analyses. Arthroscopy 31:1207–1215. https://doi.org/10.1016/j.arthro.2014.11.040

    Article  PubMed  Google Scholar 

  39. Geßlein M, Roessler PP, Schüttler KF, Biber R, Bail HJ, Efe T (2015) Complications and failure of MPFL reconstruction with free tendon grafts in cases of patellofemoral instability. Technol Health Care 23:659–666. https://doi.org/10.3233/THC-151020

    Article  PubMed  Google Scholar 

  40. Patel NK, de Sa D, Vaswani R, Kay J, Musahl V, Lesniak BP (2019) Knee flexion angle during graft fixation for medial patellofemoral ligament reconstruction: a systematic review of outcomes and complications. Arthroscopy 35:1893–1904. https://doi.org/10.1016/j.arthro.2018.11.071

    Article  PubMed  Google Scholar 

  41. Thaunat M, Erasmus PJ (2009) Management of overtight medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 17:480–483. https://doi.org/10.1007/s00167-008-0702-z

    Article  PubMed  Google Scholar 

  42. Weber AE, Nathani A, Dines JS, Allen AA, Shubin-Stein BE, Arendt EA et al (2016) An algorithmic approach to the management of recurrent lateral patellar dislocation. J Bone Joint Surg Am 98:417–427. https://doi.org/10.2106/JBJS.O.00354

    Article  PubMed  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. School of Physical Education and Sport Science, Sports Medicine and Exercise Biology Section, National and Kapodistrian University of Athens, Athens, Greece

    Georgios Kalinterakis, Iakovos Vlastos, Elina Gianzina & Christos K. Yiannakopoulos

  2. Department of Orthopaedics, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Nikolaos Platon Sachinis

Authors
  1. Georgios Kalinterakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iakovos Vlastos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elina Gianzina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nikolaos Platon Sachinis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christos K. Yiannakopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georgios Kalinterakis.

Ethics declarations

Conflict of interest

All authors report no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kalinterakis, G., Vlastos, I., Gianzina, E. et al. Medial patellofemoral ligament reconstruction using patella bone tunnel techniques with or without implants. A systematic review of outcomes and complications. Eur J Orthop Surg Traumatol 33, 3225–3234 (2023). https://doi.org/10.1007/s00590-023-03559-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-023-03559-1

Keywords

Search

Navigation