Medial Patellofemoral Complex Reconstruction, Isolated Medial Quadriceps-Tendon Femoral Ligament Reconstruction, and Isolated Medial Patellofemoral Ligament Reconstruction Have Similar Clinical and Biomechanical Outcomes: A Systematic Review.

Abstract

To determine the clinical and biomechanical outcomes after either an isolated medial quadriceps-tendon femoral ligament (MQTFL) reconstruction or a medial patellofemoral complex reconstruction, which is a combined MQTFL reconstruction and medial patellofemoral ligament (MPFL) reconstruction, to treat recurrent patellar dislocation and compare these outcomes with those after an isolated MPFL reconstruction. We conducted a systematic literature search using PubMed, The Cochrane Library, Embase, and Web of Science to compare the effectiveness of double-bundle MPFL/MQTFL reconstruction or an isolated MQTFL reconstruction with an isolated MPFL reconstruction for patients with a history of patellar dislocation. The risk of bias in nonrandomized studies of interventions and the biomechanics objective basic science quality assessment tool score were used to assess the methodological quality of included clinical studies and cadaveric studies, respectively. A total of 444 articles were screened, yielding 13 studies for inclusion, comprising 7 clinical and 6 cadaveric studies. Given the low evidence levels of the included studies, a meta-analysis was not performed. The clinical studies enrolled 300 patients, demonstrating significant improvements in patient-reported outcomes following double-bundle MPFL/MQTFL reconstruction or MQTFL reconstruction. The rate of return to sports following double-bundle MPFL/MQTFL reconstruction or isolated MQTFL reconstruction ranged from 50% to 96.9%, with a complication rate ranging from 3.3% to 28%. Six cadaveric studies, involving 51 knee specimens, indicated no significant statistical differences in lateral patellar translation, patellar tilt, patellofemoral contact area, and patellofemoral contact pressure among 3 procedures at different knee flexion angles. This study combined clinical outcomes and biomechanical findings, demonstrating significant functional improvement after both MQTFL reconstruction and double-bundle MPFL/MQTFL reconstruction, with comparable clinical and biomechanical results to MPFL reconstruction. MQTFL reconstruction or double-bundle MPFL/MQTFL reconstruction may serve as alternatives to MPFL reconstruction for treating patellar dislocation.