Concomitant cartilage restoration does not demonstrate consistent additional clinical benefit in medial patellofemoral ligament reconstruction: A systematic review.

Abstract

This review specifically evaluates whether the presence of cartilage lesions, or their surgical treatment, modifies the clinical benefit of medial patellofemoral ligament (MPFL) reconstruction. A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Embase, PubMed and Ovid MEDLINE were searched from inception to December 2025. Studies reporting MPFL reconstruction outcomes in adults with reported cartilage lesions and/or concomitant cartilage procedures were included. Comparative studies were analysed as MPFL reconstruction with cartilage restoration versus MPFL reconstruction without cartilage restoration. Cartilage restoration included microfracture, osteochondral grafting, chondrocyte implantation and fixation of osteochondral lesions. Chondroplasty, debridement and no cartilage treatment were classified as nonrestorative. Data were synthesised narratively and with weighted summary statistics. Eighteen studies comprising 1632 patients were included. The mean age was 22.2 years, 32.5% of patients were male, and the mean follow-up was 40.8 months. Cartilage lesions were graded using the International Cartilage Repair Society or Outerbridge classifications. Grade II-IV cartilage lesions were reported in 56.3% of patients, most commonly involving the patella. High-grade (III-IV) lesions were associated with worse baseline scores compared to lower-grade (0-II) lesions. MPFL reconstruction consistently led to significant improvements in pain and function, irrespective of lesion presence or treatment strategy. Weighted summary mean improvements were similar between patients undergoing MPFL reconstruction with cartilage restoration versus no restoration, based on Knee injury and Osteoarthritis Outcome Score (KOOS) Pain (+24.5 [standard deviation, SD = 2.9] vs. +26.2 [2.3]), Kujala (+32.0 [16.6] vs. +30.4 [4.3]) and International Knee Documentation Committee (IKDC) (+25.0 [5.7] vs. +32.7 [1.4]) scores. Chondroplasty and debridement were included in the no restoration category when reported. Reported complication rates were higher with cartilage restoration (5.7%) compared with no restoration (2.8%), although reporting was limited. Cartilage lesions are common during MPFL reconstruction and may be associated with worse baseline scores. MPFL reconstruction improves pain and function, but current evidence does not demonstrate a consistent additional clinical benefit of concomitant cartilage restoration. Higher-quality comparative studies with longer follow-up are needed. Level IV, systematic review.