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Medial patellofemoral ligament reconstruction with and without trochleoplasty for patients with patella instability—correlation of trochlear dysplasia and patient outcome, classification and outcome measure in the past decade—a systematic review

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A Correction to this article was published on 28 June 2021

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Abstract

Purpose

The primary aim of the study is to compare the patient outcome in medial patellofemoral ligament reconstruction (MPFLR) or MPFLR concurrent with trochleoplasty (MPFLR + TP) and correlate it with the degree of trochlear dysplasia (TD). The secondary aim is to review TD classification, outcome measure, chronological and geographical trend of such studies in the past decade.

Methods

A systemic review of the literature in the past decade on studies of patients with patella instability and underwent either a MPFLR or MPFLR + TP. The degree of TD with the patient outcome was correlated and compared between the 2 groups. The TD classification, outcome measures, chronological and geographical trends of these studies were documented.

Results

There is no statistical difference in the overall improvement in the compared outcome scores between the 2 groups. However, the MPFLR studies reported a total of 16 re-dislocation in contrast to none in the MPFLR + TP studies. The 24 selected studies in the current review utilized different TD classification as well as outcome measures. A more homogeneous subgroup of 12 studies utilized Dejour classification as well as Kujala score that enabled comparison and showed no significant difference in outcome. The highest number of MPFLR publications was in 2019 and was from North and South Americas, Asia and Europe. The MPFLR + TP studies were from Europe during 2013 to 2017.

Conclusion

Though there is an overall improvement in post-operative outcomes scores with no statistical significance between MPFLR and MPFLR + TP, the documented re-dislocations in the MPFLR studies suggested an undetermined zone where the choice of procedure could result in a different outcome. The current review did not show correlation between the degree of TD with the patient outcome to provide a clear indication for either procedure according to the degree of TD. The diverse TD classifications and varied outcome measures indicated the need for standardization and consistency in documentation to guide the treating clinician in the choice of procedure. MPFLR was more commonly performed and studied than MPFLR + TP in the past decade.

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Acknowledgement

We would like to acknowledge Luming Shi for her assistance in the overview of the literature search.

Funding

The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants or other support was received.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore

    Cheryl Marise Peilin Tan & Sir Young James Loh

  2. Consortium for Clinical Research and Innovation, Singapore Clinical Research Institute, Singapore, Singapore

    Yanan Zhu & Liang Guo

  3. Cochrane, Singapore

    Yanan Zhu & Liang Guo

Authors
  1. Cheryl Marise Peilin Tan
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  2. Yanan Zhu
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  3. Liang Guo
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  4. Sir Young James Loh
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Sir Young James Loh and Cheryl Marise Peilin Tan. Material preparation, literature search and data analysis were performed by Yanan Zhu and Liang Guo. The first draft of the manuscript was written by Cheryl Marise Peilin Tan, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Cheryl Marise Peilin Tan.

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The authors have no relevant financial or non-financial interests to disclose. The authors have no conflict of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

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The original online version of this article was revised: Author names was incorrect. Luming Shi is not an author.

Supplementary Information

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590_2021_3030_MOESM1_ESM.pdf

Detailed PubMed search strategy((((patella* and dislocation) OR (patella* and instab*)) OR ((trochle*) AND ((dysplas*) OR(bone dysplasia[MeSH Terms])))) AND (((((((medial patellofemoral ligament) OR (medialpatello-femoral ligament)) OR (medial patellofemoral ligament[MeSH Terms])) OR (MPFL))OR (medial reefing)) OR (adductor sling)) OR (patella* and tunne*))) AND(((((trochleoplasty) OR trochleaplasty) OR ((trochle*) AND ((osteotomy) OR (deepening ORremodeling)))) OR (Albee OR Bereiter OR "recession wedge")) OR arthroscop*) Filters:Clinical Study, Clinical Trial, Comparative Study, Controlled Clinical Trial, Meta-Analysis,Observational Study, Randomized Controlled Trial, Systematic Reviews, Humans

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Tan, C.M.P., Zhu, Y., Guo, L. et al. Medial patellofemoral ligament reconstruction with and without trochleoplasty for patients with patella instability—correlation of trochlear dysplasia and patient outcome, classification and outcome measure in the past decade—a systematic review. Eur J Orthop Surg Traumatol 32, 595–607 (2022). https://doi.org/10.1007/s00590-021-03030-z

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