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Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

It has been suggested that in the majority of patellar dislocation cases the medial patellofemoral ligament (MPFL) is disrupted. Accordingly several authors over the past decade have recommended repair or reconstruction of the MPFL to reduce the high incidence of recurrent dislocation. The purpose of this review was to determine whether MPFL reconstruction is a suitable procedure with regards to clinical and radiological outcomes for patients with patellar instability. A literature search using the electronic databases AMED, British Nursing Index, CINAHL, the Cochrane database, EMBASE, ovid Medline, Physiotherapy Evidence Database (PEDro), PsycINFO, Pubmed and Zetoc were performed from their inception to May 2007. All English language, human subject clinical papers reporting outcomes following MPFL reconstruction were included. Eight papers, collectively assessing 186 MPFL reconstructions, were finally included for review. Three reviewers independently assessed the methodological quality of each of the studies using the CASP appraisal tool. When analysed, it would appear that MPFL reconstruction may provide favourable clinical and radiological outcomes for patellar instability patients. However, following a critical appraisal of these papers a number of methodological weaknesses were identified including recruiting small samples, not controlling for confounding variables, and providing limited statistical analysis of results. Future study is recommended to address these methodological flaws, in addition to beginning to assess the effectiveness of this procedure, in different patient groups.

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Acknowledgements

We would like to thank Mr Simon Donell, Consultant Orthopaedic Surgeon at the Norfolk and Norwich University Hospital, for his technical advice on MPFL reconstructions, provided during the preparation of this paper. We also thank Ms Leigh Davies for her assistance in the preparation of this paper.

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Authors and Affiliations

  1. Orthopaedic Physiotherapy Research Unit, Physiotherapy Department, Out-Patients East, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Toby O. Smith, James Walker & Nicola Russell

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  1. Toby O. Smith
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  2. James Walker
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  3. Nicola Russell
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Correspondence to Toby O. Smith.

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Smith, T.O., Walker, J. & Russell, N. Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg Sports Traumatol Arthr 15, 1301–1314 (2007). https://doi.org/10.1007/s00167-007-0390-0

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