Affiliation:
1. Faculty of Health Sciences McMaster University Hamilton ON Canada
2. Michael DeGroote School of Medicine McMaster University Hamilton ON Canada
3. Department of Medicine, Department of Surgery University of Limerick Limerick Ireland
4. Division of Orthopaedic Surgery, Department of Surgery McMaster University Medical Centre 1200 Main St West 4E14L8N 3Z5 Hamilton ON Canada
5. Division of General Surgery, Department of Surgery McMaster University Medical Centre Hamilton ON Canada
Abstract
AbstractPurposeTo determine the most optimal surgical technique for medial patellofemoral ligament reconstruction (MPFLR).MethodsThree databases MEDLINE, PubMed, and EMBASE were searched from inception to December 13th, 2022, for level I or II studies comparing MPFLR techniques. The authors adhered to the PRISMA and R‐AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on patient‐reported outcome measures were recorded. Quality assessment was carried out using the MINORS and Cochrane Risk of Bias assessment tools. Certainty of evidence was carried out with the GRADE assessment tool.ResultsTen studies comprising 723 patients (723 knees) were included in this review. The weighted mean difference in Kujala, Lysholm, and IKDC scores comparing single‐ and double‐tunnel patellar drilling techniques was 2.66 (95% CI −1.05–6.37, p = 0.16, I2 = 0%) with moderate certainty, 0.78 (95% CI −9.02–10.58, p = 0.88, I2 = 87%) with low certainty, and 1.71 (95% CI −2.43–5.86, p = 0.42, I2 = 0%) with low certainty, respectively. Double‐suture anchor patellar fixation demonstrated greater Kujala scores than transpatellar fixation (87.1 ± 2.8 vs 84.0 ± 3.8, p < 0.001) with moderate certainty. Y‐shaped graft patellar fixation demonstrated superior Kujala scores to C‐shaped graft patellar fixation (95.9 ± 4.7 vs 91.3 ± 9.7, p = 0.001) with moderate certainty. Augmentation of femoral fixation with polyester sutures demonstrated superior Kujala scores (97.8 ± 6.4. vs 88.0 ± 6.3, p < 0.005) with low certainty. Four‐stranded grafts demonstrated greater Kujala scores than two‐stranded grafts (93.5 ± 2.6 vs 91.6 ± 3.5, p = 0.01) with low certainty.ConclusionThe optimal MPFLR surgical technique is likely to utilize a four‐stranded graft using either endobutton, double‐suture anchor, or transosseous suture patellar fixation with polyester suture augmented interference screw femoral fixation. Orthopedic surgeons can consider employing such a technique to improve patient outcomes by conferring greater graft stability, strength, and function.Level of evidence Level II.
Subject
Orthopedics and Sports Medicine,Surgery
Cited by
5 articles.
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