Medial Patellofemoral Ligament Reconstruction For Patellar Dislocation: Clinical Study

1.Reconstruction versus repair of medial patellofemoral ligament for the treatment of patients with recurrent patellar dislocations: A systematic review and meta-analysisObjective: Medial patellofemoral ligament(MPFL)repair and MPFL reconstruction are important treatments for recurrent patellar dislocation(RPD).However,there is no consensus on which surgical method is better for the treatment of recurrent patellar dislocation.The aim of this study was to perform a meta-analysis to compare the efficacy and safety of medial patellofemoral ligament reconstruction and repair in the treatment of recurrent patellar dislocation.Methods: A systematic search of published literature according to PRISMA guidelines was conducted through October 20,2022.Databases used to search studies included Web of Science,Pubmed,Cochrane,and Embase libraries.Relevant controlled trials were selected.Rev Man 5.4 software was used to analyze the extracted data.The primary outcomes were redislocation rate and complication rate.The secondary outcomes included imaging results(CA,PTA,PLS),Kujala score,Lysholm score,and Tegner score.Results: A total of 8 controlled trials involving 379 patients(178 patients undergoing MPFL repair and 201 patients undergoing MPFL reconstruction)were included in this meta-analysis.There were a significant differences in re-dislocation rate(P=0.008),imaging results(P < 0.0001)and Lysholm score(P=0.003)between the two surgical methods.MPFL reconstruction is superior to MPFL repair in redislocation rate,imaging results and Lysholm score.There were no significant differences in complications(P=0.65),Kujala score(P=0.53)and Tegner score(P= 0.87)between the two groups.Conclusion: The results of meta-analysis showed that there were significant differences in the redislocation rate,imaging results and Lysholm score between MPFL reconstruction and repair.MPFL reconstruction reduced the incidence of redislocation,improved imaging results and Lysholm score.Compared with MPFL repair,MPFL reconstruction did not significantly reduce the incidence of complications,and there was no significant difference in the improvement of anterior knee pain and joint range of motion after surgery.2.Early clinical outcome Analysis of all suture anchors MPFL reconstruction in the treatment of recurrent patellar dislocationObjective: To investigate the effectiveness and safety of MPFLR with allsuture anchor in the treatment of RPD.Methods: A retrospective study was conducted on 30 patients with RPD who were treated with medial patellofemoral ligament reconstruction with full suture anchor from May 2020 to June 2021 and met the inclusion criteria,including 12 males and 18 females.The mean age was 18.8±4.6 years(range,11-27 years).The main preoperative symptoms were falling down stairs or walking,joint instability,and multiple patellar dislocations.Physical examination showed patellar apprehension test(±).The patellar tilt Angle(PTA)was measured before and after operation.The Tegner knee activity score,Lysholm knee score,and Kujala subjective score were used to evaluate knee function before and after operation.Results: All patients were followed up for 12-21 months,and average is 14.5(13,19)months.During the follow-up period,there was no complication such as poor healing of the incision,redislocation,or fracture.At the last follow-up,the PTA was26.27±6.4° preoperatively and 13.35±4.38° postoperatively.The preoperative Lysholm score was 56.47 ± 5.75,6 months after operation was 82.60±4.52,12 months after operation was 93.30±5.11,the score was significantly higher than that before operation(P<0.001),the knee joint function was improved;The Kujala score was 51.57±5.81 before operation,79.30 ± 4.74 at 6 months after operation,and 91.50±3.86 at 12 months after operation,which was significantly higher than that before operation(P<0.001).The function of patellofemoral joint was improved.The preoperative Tegner score was2.37±0.89,and the postoperative Tegner score was 5.13±0.78,which was significantly higher than that before surgery(P<0.001),and the patient’s motor ability was restored.Conclusion: The all-suture anchor MPFL reconstruction is a safe and effective method for the treatment of recurrent patellar dislocation,which has good clinical efficacy.There is no redislocation after operation,the knee joint function is significantly improved compared with that before operation,and the incidence of surgical complications is reduced.However,at present,this method is mainly used for recurrent patellar dislocation,and its effect on patients with other significant anatomical deformities needs further clinical application to verify.