Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 12, pp 3869–3877 | Cite as

Results of medial patellofemoral ligament reconstruction compared with trochleoplasty plus individual extensor apparatus balancing in patellar instability caused by severe trochlear dysplasia: a systematic review and meta-analysis

  • Peter Balcarek
  • Stephan Rehn
  • Nick R. Howells
  • Jonathan D. Eldridge
  • Keisuke Kita
  • David Dejour
  • Manfred Nelitz
  • Ingo J. Banke
  • Delphine Lambrecht
  • Markus Harden
  • Tim Friede
Knee

Abstract

Purpose

Many studies have reported satisfactory clinical outcomes and low redislocation rates after reconstruction of the medial patellofemoral ligament (MPFL) for the treatment of lateral patellar instability. Despite uncorrected severe trochlear dysplasia (Dejour type B to D) being acknowledged as a major reason for less favourable clinical outcomes and a higher incidence of patellar redislocations after an isolated MPFL reconstruction, the evidence for a deepening trochleoplasty procedure remains scarce in the current literature. The hypothesis of this systematic review and meta-analysis was that a deepening trochleoplasty in combination with an a la carte extensor apparatus balancing procedure provides lower redislocation rates and superior clinical outcomes than isolated MPFL reconstruction in patients with lateral patellar instability caused by severe trochlear dysplasia.

Methods

A systematic review of the literature was conducted using specific inclusion and exclusion criteria for clinical studies reporting index operations (trochleoplasty and MPFL reconstruction) for the treatment of patellar instability caused by severe trochlear dysplasia. The Kujala score was analysed as the primary clinical outcome parameter in a random effects meta-analysis.

Results

Ten uncontrolled studies with a total of 407 knees (374 patients) were included in this analysis. The MPFL group comprised 4 studies with a total of 221 knees (210 patients), and the trochleoplasty group comprised 6 studies with a total of 186 knees (164 patients). The mean preoperative Kujala score ranged between 50.4 and 70.5 in the MPFL group and between 44.8 and 75.1 in the trochleoplasty group. The pooled Kujala score increased significantly by 26.4 (95% CI 21.4, 31.3; P < 0.00001) points in the MPFL group and by 26.2 (95% CI 19.8, 32.7; P < 0.00001) points in the trochleoplasty group. The post-operative patellar redislocation/subluxation rate was 7% in the MPFL group and 2.1% in the trochleoplasty group.

Conclusion

This analysis found significant post-operative improvements in patient-reported outcomes for patients undergoing both an MPFL reconstruction and in those undergoing a trochleoplasty plus an individual extensor apparatus balancing procedure when assessed using the Kujala score. The likelihood of preventing the patella from subsequent post-operative redislocation/subluxation was, however, greater in patients who underwent trochleoplasty plus extensor balancing.

Level of evidence

IV.

Keywords

Patellar instability Trochlear dysplasia Trochleoplasty Medial patellofemoral ligament MPFL MPFL reconstruction 

Notes

Acknowledgements

This study was performed at the University Medical Center Göttingen, Göttingen, Germany.

Authors contributions

PB contributed to conception and design, analysis and interpretation of data, drafting the manuscript, and final approval; SR helped in acquisition of data, analysis and interpretation of data, and final approval; NH contributed to acquisition and interpretation of data and final approval; JDE contributed to acquisition and interpretation of data and final approval; KK helped in acquisition and interpretation of data and final approval; DD contributed to acquisition and interpretation of data and final approval; MN contributed to acquisition and interpretation of data and final approval; IJB helped in acquisition and interpretation of data and final approval; DL helped in acquisition and interpretation of data and final approval; MH contributed to acquisition of data, analysis and interpretation of data, and final approval; and TF helped in analysis and interpretation of data and final approval.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

For this type of study (systematic review and meta-analysis) formal consent is not required.

Funding

This study received no funding.

Informed consent

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

Supplementary material

167_2016_4365_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Peter Balcarek
    • 1
    • 2
  • Stephan Rehn
    • 2
  • Nick R. Howells
    • 3
  • Jonathan D. Eldridge
    • 3
  • Keisuke Kita
    • 4
  • David Dejour
    • 5
  • Manfred Nelitz
    • 6
  • Ingo J. Banke
    • 7
  • Delphine Lambrecht
    • 8
  • Markus Harden
    • 9
  • Tim Friede
    • 9
  1. 1.Arcus SportklinikPforzheimGermany
  2. 2.Department of Trauma Surgery and OrthopaedicsUniversity Medical Center GöttingenGöttingenGermany
  3. 3.Avon Orthopaedic CentreBristolEngland, UK
  4. 4.Department of Sports OrthopaedicsOsaka Rosai HospitalOsakaJapan
  5. 5.Knee and Sportmedicine DepartmentLyon-Ortho-ClinicLyonFrance
  6. 6.MVZ OberstdorfClinics Kempten-OberallgäuOberstdorfGermany
  7. 7.Department of Orthopedic Sports Surgery, Klinikum Rechts Der IsarTU MünchenMunichGermany
  8. 8.Department of Orthopaedic Surgery and TraumatologyGhent University HospitalGhentBelgium
  9. 9.Department of Medical StatisticsUniversity Medical Center GöttingenGöttingenGermany

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