Isolated Medial Patellofemoral Ligament Reconstruction Results in Lower Failure and Complication Rates Than Isolated Trochleoplasty and Tibial Tubercle Osteotomy: A Systematic Review

Abstract

PurposeTo evaluate outcomes and complications of isolated medial patellofemoral ligament (MPFLR), tibial tubercle osteotomy (TTO), and trochleoplasty for management of patellar instability. MethodsA query of Scopus, PubMed, Google Scholar, Cochrane CENTRAL Register of Controlled Trials, and the Cochrane Database of Systematic Reviews was performed in accordance with 2020 PRISMA guidelines. Included studies reported clinical outcome data after isolated MPFLR, TTO, or trochleoplasty for patellar instability with a minimum of 12 months of follow-up. Meta-analysis and data aggregation was not performed. ResultsThirty-six studies (5 trochleoplasty, 14 TTO, and 18 MPFLR) consisting of 1,389 patients (114 trochleoplasty, 374 TTO, and 1,001 MPFLR) were included. Risk of bias was assessed with the Methodological Index for Non-Randomized Studies (MINORS) score which ranged from 11–12 in trochleoplasty, 10–18 in TTO, and 8–18 in MPFLR studies. Patient reported outcome measures including Lysholm Score (trochleoplasty: 51.1–71 to 71–95y; TTO: 57–63.3 to 84–98; MPFLR: 37.4–59.1 to 74–92.5), Kujala Score (trochleoplasty: 56–71 to 78–92; TTO: 48.6–68 to 78–92; MPFLR: 53.3–60 to 81.5–92), VAS Pain Scale (trochleoplasty: 52 to 25; TTO: 54–76 to 14–27; MPFLR: 29 to 17, out of 100), and Tegner Score (TTO: 3–4 to 3–4; MPFLR: 2.5–6 to 4.9–5) improved after all surgeries. Failure rates ranged from 0–33.3% after MPFLR, 0–30.8% after TTO, and 5.3–40% after trochleoplasty. Complication rates ranged from 0–14.7% after MPFLR, 1.6–58.3% after TTO, and 8–26.3% after trochleoplasty. ConclusionsIsolated MPFLR, TTO, or trochleoplasty may be effective treatment options for patellar stabilization. While failure rates were highest after isolated trochleoplasty and complication rates were highest after TTO, these procedures are not interchangeable as each addresses a specific pathology. Level of EvidenceIV; Systematic Review of Level II-IV studies