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

ABSTRACT

PURPOSE: To evaluate outcomes and complications of isolated medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), and trochleoplasty for management of patellar instability. METHODS: A 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 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies reported clinical outcome data after isolated MPFLR, TTO, or trochleoplasty for patellar instability with a minimum 12-month follow-up. Meta-analysis and data aggregation was not performed. RESULTS: Thirty-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 score, which ranged from 11 to 12 in trochleoplasty, 10 to 18 in TTO, and 8 to 18 in MPFLR studies. Patient-reported outcome measures, including Lysholm score (trochleoplasty 51.1-71 to 71-95; 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), visual analog scale for pain (trochleoplasty 52-25; 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% to 33.3% after MPFLR, 0% to 30.8% after TTO, and 5.3% to 40% after trochleoplasty. Complication rates ranged from 0% to 14.7% after MPFLR, 1.6% to 58.3% after TTO, and 8% to 26.3% after trochleoplasty. CONCLUSIONS: Isolated MPFLR, TTO, or trochleoplasty may be effective treatment options for patellar stabilization. Although 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 EVIDENCE Level IV, systematic review of Level II to IV studies.