Patellofemoral Update

Patellofemoral Update

Disclosures: Hurley reports no relevant financial disclosures. Please see the study for all other authors' relevant financial disclosures.
October 22, 2021
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MPFL reconstruction remains the ‘optimal surgical stabilization procedure’ for instability

Disclosures: Hurley reports no relevant financial disclosures. Please see the study for all other authors' relevant financial disclosures.
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Results showed medial patellofemoral ligament reconstruction yields the lowest rate of recurrent patellar instability, greatest improvements in functional outcomes and highest Kujala score compared with repair and nonoperative treatment.

In a level-1 systematic review and network meta-analysis, Eoghan T. Hurley, MB, BCh, MCh, and colleagues at NYU Langone Health performed a literature search of 13 randomized controlled trials (n = 789 patients) that compared MPFL reconstruction (n = 150), MPFL repair (n = 353) and nonoperative management (n = 286) of patellar instability. Outcome measures included recurrent patellar instability, dislocations, subluxations, redislocations and Kujala score. The three treatment options were compared using P scores, which represented “the probability that the treatment option is the ideal method for an optimal result in each outcome measure,” the researchers wrote in the study.

Hurley and colleagues found MPFL reconstruction had the highest overall P score, the highest P score among those with first-time dislocation and the lowest recurrent patellar instability rate compared with MPFL repair and nonoperative management. MPFL reconstruction also yielded the highest Kujala score compared with both MPFL repair and nonoperative management, according to the study.

“In our network meta-analysis, we established that MPFL reconstruction significantly reduced the rates of recurrent instability and redislocation and is the optimal surgical stabilization procedure for patellar instability,” the researchers added. “These findings contradict those of authors who have advocated the role of MPFL repair as the primary method of stabilization in patients with first-time dislocation,” they wrote.