Table 3 Clinical outcomes of the included studies on medial patellofemoral ligament reconstruction for patellar dislocation using autograft versus allograft
Study | Group (n) | Clinical outcomes | Complications |
|---|---|---|---|
Astur et al. [15] | Autograft: 58 Endobutton (30) Anchor (28) | There were no statistical differences among postoperative Kujala, Fulkerson, and SF-36 questionnaire scores between the endobutton and anchor fixation groups. In the endobutton group, there were favorable outcomes to shorter follow-up length (2–5 years) compared to those with a longer follow-up length (5–10 years) for both Kujala and Fulkerson scores, but no difference for the anchor fixation group | No recurrent dislocation or subluxation 1 patellar fracture in the endobutton group 3 patients had subjective complaints of discomfort in the endobutton group due to endobutton prominence 2 patients developed postoperative arthrofibrosis, one for each technique |
Bitar et al. [12] | Autograft: 21 | Treatment with MPFL reconstruction using the patellar tendon produced better outcomes compared to non-operative treatment. The Kujala score was significantly higher in the MPFL reconstruction group, when compared with the mean value of the non-operative group. The MPFL reconstruction group presented a higher percentage of good/excellent results (71.4%) when compared with the non-operative group (25.0%) | No patellar recurrent dislocation or subluxation |
Deie et al. [22] | Autograft: 46 | There were significant differences between the preoperative and postoperative Kujala scores. Based on their results, they recommended MPFL reconstruction with the advancement of the vastus medialis or with Insall’s procedure. ROM was investigated as knee extension 0° ± 5° and knee flexion of 147° ± 3° | No recurrent patellar dislocation 4 knees had experienced the subluxation sensation and the apprehension signs remained |
Deie et al. [13] | Autograft: 31 | The Kujala score improved from 64 (range, 35–70) to 94.5 (range, 79–100). ROM improved for all patients, with knee extension 0° ± 2° and knee flexion of 145° ± 3° | No patellar redislocation 1 patient remained with a positive apprehension sign |
Dragoo et al. [23] | Allograft: 8 | Based on the KOOS, Lysholm, Tegner, and VR-12 scores, there were no statistically significant differences between the MPFL repair and MPFL reconstruction groups | No recurrent patellar dislocation There were no other surgical complications, such as stiffness, infections, painful hardware, or wound problems, at final follow-up |
Drez et al. [9] | Autograft: 14 | About 80% of patients showed excellent or good results and 14% of patients had fair or poor results. Based on Fulkerson’s functional knee score, 93% had excellent or good results. Postoperative mean Kujala score was 88.6 (57–100), Tegner activity level averaged 6.8 pre-injury and 6.7 postoperatively | 10 patients had patellofemoral crepitus. 1 patient had medial facet tenderness 4 patients lost some flexion motion 9 patients had atrophy No apprehension sign |
Ellera Gomes et al. [11] | Autograft: 16 | According to Crosby-Insall criteria, about 94% of patients had excellent or good results. According to Aglietti criteria, about 88% of patients had excellent or good results | No infection and vascular problems were found 1 knee, the apprehension sign was positive, patellofemoral pain was present, and patellar tracking was abnormal Patellar crepitus was detected in 10 knees |
Han et al. [16] | Autograft: 59 | The average ROM was improved from 30 ± 2° to125 ± 5°. Both the mean Kujala score (41.4 versus 82.6) and the mean modified Cincinnati score (50.6 versus 88.7) were improved at recent follow-up. There were significant differences between preoperative and postoperative scores in both scales. In addition, the results of the very 2 scales were not associated with the presence of cartilage lesion, and sex | No patellar dislocation or subluxation No apprehension sign 3 knees developed postoperative stiffness, but resolved after 6 months of physical therapy |
Kang et al. [24] | Autograft: 82 Y-graft (40) C-graft (42) | Y-graft group versus C-graft group: mean Lysholm score were 92.3 ± 3.9 and 88.4 ± 6.8 (significant). : Mean Kujala score 95.9 ± 4.7 and 91.3 ± 9.7 (significant). : Good or excellent rate of 97.5% in the Y-graft group compared with 83.3% in the C-graft group (significant) Thus, Y-graft technique had favorable outcomes compared to C-graft procedure | No recurrent dislocation or subluxation |
Kang et al. [14] | Autograft: 45 | The mean Lysholm score increased from 51.8 ± 6.2 to 91.7 ± 4.1 and mean Kujala score was from 53.4 ± 5.3 to 90.9 ± 6.6. There were significant differences between preoperative and postoperative scores | No recurrent dislocation or subluxation None remained with a positive apprehension sign after surgery |
Ma et al. [25] | Autograft: 32 | When MPFL reconstruction technique was compared to medial retinaculum plasty, medial retinaculum plasty yielded similar results to MPFL reconstruction for recurrent patellar instability. Median Kujala score improved from 54 (46–63) to 87 (78–100)' Median Tegner score improved from 3 (1–5) to 5 (2–8). There were no significant differences in Kujala, Tegner, and subjective questionnaire scores between medial retinaculum plasty and MPFL reconstruction groups. About 88% of patients had excellent or good results | In 3 patients (9%) in the MPFL reconstruction group, patellar lateral shift was observed that exceeded 1.5 cm but was less than 2.0 cm. 2 knees had mild anterior knee pain and limitation during flexion activities. A flexion deficit of less than 5° remained at final evaluation No extension deficit |
Mikashima et al. [17] | Autograft: 24 Anchor (12) Patellar tunnel (12) | Postoperative mean Kujala score was improved from 30.5 ± 6.7 to 95.2 ± 12.9 (range, 82–100). About 76.5% of patients resumed sports activity at the previous level. Extensor and flexor strength of the affected knee to the unaffected knee were improved. The author recommended suturing to fibrous tissue and the patellar periosteum as the first choice | 2 cases of patellar fracture 1 case had a persistent patellar apprehension sign |
Niu et al. [26] | Autograft: 22 | Mean Kujala score improved significantly from 56.7 ± 17.7 to 86.8 ± 14.4 at 48 months follow-up. Mean Lysholm score improved significantly from 59.9 ± 3.8 to 92.4 ± 1.9 at 48 months follow-up. The clinical outcomes of the MPFL reconstruction group are better than that of the medial retinaculum plasty group | No superficial wound infection No deep vein thrombosis and ROM limitation No patellar redislocation |
Nomura et al. [27] | Autograft: 12 | Kujala score improved from 61.7 ± 4.9 to 96.0 ± 5.2. According to the grading system of Insall, 83% of patients had excellent or good results and 17% of patients had fair results. There was no poor result | No recurrent dislocation or subluxation No positive apprehension sign No perioperative complications |
Panni et al. [28] | Autograft: 48 | Mean Kujala score improved significantly from 56.7 ± 17.7 to 86.8 ± 14.4. Mean Larsen score improved significantly from 12.4 ± 3.2 to 17.1 ± 2.7. Mean Fulkerson’s knee score improved significantly from 59.2 ± 21.8 to 90.1 ± 14.0. Mean modified Lysholm score improved significantly from 57.6 ± 19.6 to 88.1 ± 16.2. 87% of patients were either satisfied or very satisfied with the pain relief achieved | No patellar dislocation postoperatively |
Ronga et al. [29] | Autograft: 28 | Mean modified Cincinnati score increased from 52 ± 19 (range, 44–67) to 89 ± 21 (range, 74–100). Mean Kujala score increased from 45 ± 17 (range, 39–53) to 83 ± 14 (range, 74–91). Both clinical scales did not show significant differences in patients with and without osteochondral lesions. There were no significant differences in the Insall-Salvati Index between preoperative and postoperative results. The muscle volume of the thigh of the operated limb increased with time, but remained less well developed than those of the non-operated limb | 2 patients reported persistent anterior knee pain 2 female patients were found to have knee-joint stiffness 3 male patients experienced a new episode of patellar dislocation |
Schottle et al. [30] | Autograft: 15 | Mean Kujala score improved from 53.3 (range, 31–76) to 85.7 (range, 55–100) at latest follow-up. 86% of patients had excellent or good results and 13% of patients had fair results. Previous surgery or mild trochlear dysplasia had no influence on the clinical outcomes. MPFL reconstruction reduces patellar tilt and may correct patellar alta | 3 knees with persistent patellar apprehension |
Torisuka et al. [31] | Autograft: 20 | The average postoperative Kujala score was 96 ± 5 (84–100). According to Crosby-Insall criteria, all patients were graded as having excellent or good outcomes | No redislocation or patellar fracture 1 patient with patella infera due to arthrofibrosis |
Vavalle et al. [32] | Autograft: 16 | Both Kujala score and Lysholm scores were improved from 35.8 and 43.3 to 88.8 and 89.3, respectively | No recurrent episodes of dislocation or subluxation No complication occurred. |
Wang et al. [33] | Autograft: 70 SB: 26 DB: 44 | Both SB and DB MPFL reconstruction can effectively restore patellar stability and improve knee function. DB MPFL reconstruction showed better clinical outcomes compared to those of SB MPFL reconstruction. Patellar instability rates: SB: 19.2% and 26.9% at 12 months and 48 months (significant), DB: 2.27% and 4.54% at 12 months and 48 months, respectively (n. s.). Kujala score: SB: 87.8 ± 4.0 and 80.5 ± 3.6 at 12 months and 48 months (significant), DB: 92.3 ± 4.3 and 92.9 ± 2.5 at 12 months and 48 months, respectively (n. s.). Subjective questionnaire score SB: excellent and good rates were 88.5% and 80.8% at 12 months and at 48 months, DB: excellent and good rates were 97.7% and 95.5% at 12 months and at 48 months, respectively | Superficial wound infection occurred in 1 patient of each group. There was no deep vein thrombosis or ROM limitation in either group Patellar redislocation: 3 in SB group, none in DB group |
Witonski et al. [34] | Autograft: 10 | There were significant improvements found between preoperative and postoperative results in terms of clinical scales such as the Kujala score, the KOOS questionnaire, and most aspects of the SF-36 questionnaire | No recurrent dislocation |
Zhao et al. [35] | Autograft: 45 | When the MPFL reconstruction technique was compared to medial retinaculum plication, there were significantly favorable outcomes in IKDC, Lysholm and Kujala scores at the 60 months’ follow-up. IKDC subjective score improved from 46.3 ± 4.4 to 79.4 ± 6.8 at 60 months’ follow-up. Lysholm score improved from 52.1 ± 8.4 to86.9 ± 6.1 at 60 months’ follow-up. Kujala score improved from 68.9 ± 6.8 to 87.4 ± 5.7 at 60 months’ follow-up. Tegner score improved from 3.1 ± 1.9 to 5.7 ± 1.7 at 60 months’ follow-up | 1 patient experienced an episode of redislocation. 3 patients experienced multiple episodes of patellar instability The failure rate of the MPFL reconstruction group was revealed as 8.9% |