Medial Patellofemoral Ligament Reconstruction Techniques and Outcomes: a Scoping Review.

Abstract

The purpose of this scoping literature review was to summarize the current evidence on techniques and outcomes following MPFL reconstruction including sources of evidence, key concepts, and gaps in the literature. A thorough electronic database search included studies published from 2016 to April 26, 2021, identified a total of 144 peer reviewed articles. Of the 144 identified clinical papers, 80 (56%) were of level IV evidence, 49 (34%) were of level III evidence, 11 (8%) were level II evidence, and 4 (3%) were level I evidence. Overall, 10,710 patients (11,466 knees) were included with 6871 (64%) female. The mean age of patients included in these studies was 23.5 years (range=5 to 59). In recent years, there has been a substantial quantity of evidence published on MPFL reconstruction from a variety of different countries and journals and of variable methodological design. Isolated MPFL reconstruction results in a decrease in patellar height postoperatively. Indications for isolated MPFL reconstruction versus concomitant procedures to address bony morphology is still incompletely defined. When failure does occur after MPFL reconstruction, femoral tunnel malposition is the most commonly cited cause. Despite several recent studies focused on optimal MPFL reconstruction techniques, there is currently no consensus on optimal graft type (most common being hamstring autografts, allografts, and recently synthetic grafts) or femoral fixation strategies, with similar results reported with each technique. Future studies should focus on optimal techniques for each patient population as well as specific indications for additional concomitant realignment procedures.