Patellar Dislocation: Workup and Decision-Making.

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Abstract

Conflict of interest statement: The authors have declared that no competing interests exist. 7. J Orthop Surg Res. 2022 Feb 22;17(1):121. doi: 10.1186/s13018-022-03008-5. Hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective. Marín Fermín T(1), Migliorini F(2), Kalifis G(3), Zikria BA(1), D'Hooghe P(1), Al-Khelaifi K(1), Papakostas ET(1), Maffulli N(4)(5)(6). Author information: (1)Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. (2)Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. migliorini.md@gmail.com. (3)Department of Trauma and Orthopaedics, Hull Royal Infirmary, Hull, UK. (4)Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy. (5)School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, England. (6)Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, England. PURPOSE: This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on patient-reported outcome measures (PROMs), redislocation rate, and complications. The hypothesis was that hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective. METHODS: This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library databases were accessed in October 2021. All the clinical studies investigating the efficacy and feasibility of hardware-free MPFL reconstruction were screened for inclusion. Only studies with a minimum 24-month follow-up were considered eligible. Kujala Anterior Knee Pain Scale improvement and redislocation rate after surgical treatment were evaluated as primary outcomes. The rate of postoperative complications was evaluated as a secondary outcome. The quality of the methodological assessment was assessed using the Modified Coleman Methodology Score. RESULTS: Eight studies were included in the present systematic review. The quality of the methodological assessment was moderate. Short- to long-term improvement of Kujala score was observed in all included studies. Mean score improvement ranged from + 13.2/100 to + 54/100, with mean postoperative scores ranging from 82/100 to 94/100. Patellar redislocation was observed in 8.33% (8 of 96) patients. CONCLUSION: Hardware-free MPFL reconstruction with or without associated soft-tissue or bony realignment procedures provided reliable clinical improvements and was associated with a low rate of redislocation in patients with recurrent patellofemoral instability. Advantages such as safety, femoral physis preservation, and comparable complication profiles with implant-based techniques endorse its implementation. Orthopedic surgeons in cost-sensitive environments may also benefit their patients with lower costs, no need for implants, lack of implant-related complications, or surgery for implant removal. LEVEL OF EVIDENCE: Level IV. © 2022. The Author(s). DOI: 10.1186/s13018-022-03008-5 PMCID: PMC8864882