Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in recurrent patellar instability: A systematic review and meta-analysis

doi:10.12998/wjcc.v11.i19.4625

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World Journal of Clinical Cases

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World J Clin Cases. Jul 6, 2023; 11(19): 4625-4634
Published online Jul 6, 2023. doi: 10.12998/wjcc.v11.i19.4625

Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in recurrent patellar instability: A systematic review and meta-analysis

Ahmad Abbaszadeh, Mohsen Saeedi, Amir Human Hoveidaei, Haleh Dadgostar, Saeed Razi, Mohammad Razi

Ahmad Abbaszadeh, Mohsen Saeedi, Department of Orthopedic, Emam Khomeini Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6135715794, Iran

Amir Human Hoveidaei, Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran 14395-578, Iran

Haleh Dadgostar, Department of Sports and Exercise Medicine, School of Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran 1445613131, Iran

Saeed Razi, Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran 1545913487, Iran

Mohammad Razi, Department of Orthopedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran 1445613131, Iran

Author contributions: Razi M, Hoveidaei AH, and Dadgostar H contributed to conception and design of the study and made critical revisions related to important intellectual content of the manuscript; Abbaszadeh A, Saeedi M, and Razi S drafted the article and performed acquisition of data and analysis and interpretation of data; all authors approved of the final version of the article to be published.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Mohammad Razi, MD, President, Professor, Surgeon, Department of Orthopedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Department of Orthopedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran 1445613131, Iran. mrazi@razimd.info

Received: January 24, 2023
Peer-review started: January 24, 2023
First decision: April 20, 2023
Revised: May 8, 2023
Accepted: May 31, 2023
Article in press: May 31, 2023
Published online: July 6, 2023
Processing time: 156 Days and 13.9 Hours

Abstract

BACKGROUND

The medial patellofemoral ligament (MPFL), along with the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament, aid in the stabilization of the patellofemoral joint. Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter, this ligament is critical in maintaining joint stability. There have been few studies on the combined MPFL and MPTL reconstruction and its benefits.

AIM

To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability.

METHODS

By May 8, 2022, four electronic databases were searched: Medline (PubMed), Scopus, Web of Science, and Google Scholar. General keywords such as "patellar instability," "patellar dislocation," "MPFL," "medial patellofemoral ligament," "MPTL," and "medial patellotibial ligament" were co-searched to increase the sensitivity of the search.

RESULTS

The pooled effects of combined MPFL and MPTL reconstruction for Kujala score (12-mo follow-up) and Kujala score (24-mo follow-up) were positive and incremental, according to the findings of this meta-analysis. The mean difference between the Cincinnati scores was also positive, but not statistically significant. The combination of the two surgeries reduces pain. According to cumulative meta-analysis, the trend of pain reduction in various studies is declining over time.

CONCLUSION

The combined MPFL and MPTL reconstruction has good clinical results in knee function and, in addition to providing good control to maintain patellofemoral joint balance, the patient's pain level decreases over time, making it a valid surgical method for patella stabilization.

Keywords: Medial patellofemoral ligament reconstruction; Medial patellotibial ligament; patella dislocation; Patella instability

Core Tip: In patellar instability, combined medial patellofemoral ligament and medial patellotibial ligament reconstruction is associated with good clinical outcomes and can be considered a standard treatment in patellar instability treatment guidelines.