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Journal of Orthopaedic Surgery (Hong... 2020The aim of this study was to perform a meta-analysis to compare the effects of repair of medial patellofemoral ligament (MPFL) and conservative treatment in patients... (Comparative Study)
Comparative Study Meta-Analysis
Conservative versus repair of medial patellofemoral ligament for the treatment of patients with acute primary patellar dislocations: A systematic review and meta-analysis.
PURPOSE
The aim of this study was to perform a meta-analysis to compare the effects of repair of medial patellofemoral ligament (MPFL) and conservative treatment in patients with acute primary patellar dislocation (PPD).
METHOD
The databases we used to search the studies included MEDILINE, EMBASE, and Cochrane registry of controlled clinical trials. Five randomized controlled studies comparing the effects of MPFL repair versus conservative treatment with 300 acute PPD patients were included in the present meta-analysis. Primary outcome was redislocation rate and secondary outcomes included Kujala score, percentage of excellent or good subjective opinion, Tegner activity score, and knee injury and osteoarthritis outcome score (KOOS; pain, symptoms, and activities of daily living).
RESULTS
The outcome of the Kujala score was statistically significant between the two treatments and indicated that MPFL repair had a higher Kujala score than conservative treatment in patients with acute PPD. There was no significant difference between the two treatments regarding the redislocation rate ( = 0.32), percentage of excellent or good subjective opinion ( = 0.15), Tegner activity score ( = 0.24), and KOOS ( > 0.05).
CONCLUSIONS
Based on the available data, MPFL repair did not reduce the risk of redislocation nor did it produce any significantly better outcome based on the clinical manifestations, including anterior knee pain and knee activities. Only the Kujala score was improved by MPFL repair compared with conservative treatment.
Topics: Acute Disease; Conservative Treatment; Humans; Knee Joint; Ligaments, Articular; Patellar Dislocation; Patellofemoral Joint; Plastic Surgery Procedures
PubMed: 32552381
DOI: 10.1177/2309499020932375 -
Knee Surgery, Sports Traumatology,... Apr 2022This study updates the current evidence on the role of allografts versus autografts for medial patellofemoral ligament (MPFL) reconstruction in patients with... (Meta-Analysis)
Meta-Analysis Review
Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta-analysis.
PURPOSE
This study updates the current evidence on the role of allografts versus autografts for medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral instability.
METHODS
The study was performed according to the PRISMA guidelines. In March 2021, a literature search in the main online databases was performed. Studies reporting quantitative data concerning primary MPFL reconstruction using an allograft were considered for inclusion. The Coleman Methodology Score was used to assess the methodological quality of the selected articles.
RESULTS
Data from 12 studies (474 procedures) were retrieved. The mean follow-up was 42.2 (15-78.5) months. The mean age was 21.1 ± 6.2 years. 64.9% (285 of 439) of patients were female. At the last follow-up, the Tegner (p < 0.0001), Kujala (p = 0.002) and the Lysholm (p < 0.0001) scores were minimally greater in the autografts. The similarity was found in the rate of persistent instability sensation and revision. The allograft group evidenced a lower rate of re-dislocations (p = 0.003).
CONCLUSION
Allografts may represent a feasible alternative to traditional autograft for MPFL reconstruction in selected patients with patellofemoral instability. Allograft tendons yielded similar PROMs, rates of persistent instability, and revision. Allograft reconstructions tended to have modestly lower re-dislocation rates.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Adult; Allografts; Autografts; Female; Humans; Joint Dislocations; Joint Instability; Ligaments, Articular; Male; Patellar Dislocation; Patellofemoral Joint; Plastic Surgery Procedures; Young Adult
PubMed: 33861358
DOI: 10.1007/s00167-021-06569-w -
European Journal of Orthopaedic Surgery... Jul 2020After the first patellar dislocation, most patients report damage of the medio-patellofemoral ligament (MPFL) and surgical reconstruction is required. The purpose of...
INTRODUCTION
After the first patellar dislocation, most patients report damage of the medio-patellofemoral ligament (MPFL) and surgical reconstruction is required. The purpose of this study is to systematically review current evidence and to clarify the role of the gracilis and semitendinosus tendons as graft for isolated MPFL reconstruction.
MATERIALS AND METHODS
The present systematic review was conducted according to the PRISMA guidelines. The literature search was conducted in October 2019. All clinical trials using the semitendinosus and/or gracilis tendon grafts for isolated MPFL reconstruction in patients with patellofemoral instability were considered for inclusion. Only articles reporting a minimum of 12-month follow-up were considered. The PEDro score was used for the methodological quality assessment.
RESULTS
Data from 1491 procedures were collected. The mean follow-up was 36.12 months. There was comparability among the patient baseline. All the scores of interests (Kujala, Tegner, Lysholm) and range of motion scored better in the semitendinosus group. Moreover, in favour of the semitendinosus group, a statistically significant reduction of the revision surgeries and re-dislocations were evidenced. Apprehension test and persistent instability sensation found any statistical correlations.
CONCLUSION
Isolated MPFL reconstruction through semitendinosus tendon graft performed better than the gracilis in selected patients suffering from recurrent patellofemoral instability.
Topics: Gracilis Muscle; Hamstring Tendons; Humans; Knee Joint; Ligaments, Articular; Patellar Dislocation; Range of Motion, Articular; Plastic Surgery Procedures; Recurrence; Reoperation
PubMed: 32008097
DOI: 10.1007/s00590-020-02636-z -
Knee Surgery, Sports Traumatology,... May 2022Focal, patellar cartilage defects are a challenging problem as most cases have an underlying multifactorial pathogenesis. This systematic review of current literature... (Review)
Review
Good clinical outcomes after patellar cartilage repair with no evidence for inferior results in complex cases with the need for additional patellofemoral realignment procedures: a systematic review.
PURPOSE
Focal, patellar cartilage defects are a challenging problem as most cases have an underlying multifactorial pathogenesis. This systematic review of current literature analysed clinical results after regenerative cartilage repair of the patella with a special focus on the assessment and treatment of existing patellofemoral malalignment.
METHODS
A systematic review was conducted to identify articles reporting clinical results after cartilage regenerative surgeries of the patella using the PubMed and Scopus database. The extracted data included patient-reported outcome measures (PROMS) and whether cartilage repair was performed alone or in combination with concomitant surgeries of underlying patellofemoral co-pathologies. In cases of isolated cartilage repair, specific exclusion criteria regarding underlying co-pathologies were screened. In cases of concomitant surgeries, the type of surgeries and their specific indications were extracted.
RESULTS
A total of 35 original articles were included out of which 27 (77%) were cohort studies with level IV evidence. The most frequently used technique for cartilage restoration of the patella was autologous chondrocyte implantation (ACI). Results after isolated cartilage repair alone were reported by 15 (43%) studies. Of those studies, 9 (60%) excluded patients with underlying patellofemoral malalignment a priori and 6 (40%) did not analyse underlying co-pathologies at all. Among the studies including combined surgeries, the most frequently reported concomitant procedures were release of the lateral retinaculum, reconstruction of the medial patellofemoral ligament (MPFL), and osteotomy of the tibial tubercle. In summary, these studies showed lower preoperative PROMS but similar final PROMS in comparison with the studies reporting on isolated cartilage repair. The most frequently used PROMS were the IKDC-, Lysholm- and the Modified Cincinnati Score.
CONCLUSION
This comprehensive literature review demonstrated good clinical outcomes after patellar cartilage repair with no evidence of minor results even in complex cases with the need for additional patellofemoral realignment procedures. However, a meaningful statistical comparison between isolated patellar cartilage repair and combined co-procedures is not possible due to very heterogeneous patient cohorts and a lack of analysis of specific subgroups in recent literature.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Joint Instability; Knee Joint; Ligaments, Articular; Osteotomy; Patella; Patellar Dislocation; Patellofemoral Joint
PubMed: 34510221
DOI: 10.1007/s00167-021-06728-z -
Journal of Sport and Health Science Jan 2022The present study aimed to systematically review and compare 2 femoral autograft fixation techniques, namely, interference screws and suture anchors, for isolated medial... (Review)
Review
PURPOSE
The present study aimed to systematically review and compare 2 femoral autograft fixation techniques, namely, interference screws and suture anchors, for isolated medial patellofemoral ligament reconstruction in patients with recurrent patellofemoral instability at mid- to long-term follow-up.
METHODS
A literature search was performed in September 2020. All studies reporting the outcomes of primary isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability were considered for inclusion. Only studies reporting the type of femoral autograft fixation under examination were considered. Studies reporting data from patients with elevated tibial tuberosity-tibial groove, patella alta, and/or Dejour's trochlear dysplasia types C and D, were not included. Only articles reporting data with a minimum follow-up period of 18 months were considered.
RESULTS
Data from 19 studies (615 patients) were retrieved. The overall age was 24.4 ± 6.7 years (mean ± SD). The mean follow-up was 46.5 ± 20.9 months. There were 76 patients in the anchor group and 539 in the screw group. Comparability was found with regard to age and follow-up duration between the 2 study groups. There was comparability between the Kujala, Lysholm, and Tegner scores at baseline. At the last follow-up, no worthy differences were found in terms of mean Kujala (+2.1%; p = 0.04), Lysholm (+1.7%; p = 0.05), and Tegner (+15.8%; p = 0.05) scores. Although complications occurred almost exclusively in the screw cohort, no statistically significant difference was found.
CONCLUSION
Femoral autograft fixation through interference screws or suture anchors report similar clinical scores and rate of apprehension test, persistent joint instability, re-dislocations, and revisions. These results must be interpreted within the limitations of the present study.
Topics: Adolescent; Adult; Bone Screws; Humans; Ligaments, Articular; Patellar Dislocation; Patellofemoral Joint; Suture Anchors; Young Adult
PubMed: 33259964
DOI: 10.1016/j.jshs.2020.11.011 -
Knee Surgery, Sports Traumatology,... Sep 2018Trochleoplasty aims to restore patellar stability. Various techniques have been described and almost all authors report successful results. However, the procedure has a... (Meta-Analysis)
Meta-Analysis
PURPOSE
Trochleoplasty aims to restore patellar stability. Various techniques have been described and almost all authors report successful results. However, the procedure has a significant risk of complications. Purpose of this study was to perform a systematic review and meta-analysis of the available literature to assess the rate of complications after the various techniques used for trochleoplasty procedures.
MATERIALS AND METHODS
MEDLINE, EMBASE, Web of Science and Cochrane Library databases were searched. Studies on patients with recurrent patellar instability treated with a trochleoplasty with or without additional procedure, and reported complications were included. The primary outcome was the rate of complications per technique. A meta-analysis was performed whenever three or more studies per surgical technique could be included.
RESULTS
The selection process resulted in 20 studies included for analysis. A lateral facet elevating trochlear osteotomy was reported by two studies, ten studies reported on a Bereiter trochleoplasty, five on a Dejour trochleoplasty, one on an arthroscopic technique, one on a 'modified' technique and one on a recession wedge trochleoplasty. Meta-analysis showed that proportion of recurrent dislocation was 0.04 (95% CI 0.02-0.07) for Bereiter trochleoplasty and 0.02 (95% CI 0-0.08) for Dejour trochleoplasty. These proportions were 0.06 (95% CI 0.02-0.13) and 0.09 (95% CI 0.03-0.27) for recurrent instability, 0.07 (95% CI 0.02-0.19) and 0.12 (95% CI 0.00-0.91) for patellofemoral osteoarthritis and 0.08 (95% CI 0.04-0.14) and 0.20 (95% CI 0.11-0.32) for further surgery respectively.
CONCLUSION
This study demonstrates that the complications after a Bereiter and Dejour trochleoplasty including additional procedures are in the range of those of other patellar stabilizing procedures. For four other techniques, no meta-analysis could be performed. The clinical relevance of this study is that it provides clinicians with the best currently available evidence on the rate of complications after trochleoplasty procedures. This can be helpful in the process of deciding whether or not to perform such a procedure, and can be used to better inform patients about the advantages and disadvantages of different trochleoplasty procedures.
LEVEL OF EVIDENCE
Level IV.
Topics: Femur; Humans; Joint Instability; Osteoarthritis, Knee; Osteotomy; Patella; Patellar Dislocation
PubMed: 29210022
DOI: 10.1007/s00167-017-4766-5 -
Medical Sciences (Basel, Switzerland) Nov 2023(1) Background: Acute patella dislocation (APD) is a prevalent knee injury, with rates between 5.8-77.8 per 100,000. APD often results in repeat lateral patella... (Review)
Review
(1) Background: Acute patella dislocation (APD) is a prevalent knee injury, with rates between 5.8-77.8 per 100,000. APD often results in repeat lateral patella dislocations due to the instability of the medial patellofemoral ligament (MPFL). Non-operative treatments have a 50% recurrence rate. While autologous grafting for MPFL has been favored, surgeons are now exploring synthetic grafts. We aimed to assess the effectiveness of synthetic grafts in MPFL reconstruction surgeries for repeated patellar dislocations; (2) Methods: Our research was based on a thorough search from the National Institute of Health and Clinical Excellence Healthcare Databases, using the Modified Coleman Methodology Score for quality assessment; (3) Results: Six studies met the inclusion criteria. A total of 284 patients and 230 knees were included. Seventy-five percent of patients were graded to have excellent-good clinical outcomes using the Crosby and Insall Grading System. International Knee Documentation Committee score and Knee injury and Osteoarthritis Outcome Score scores showed 59% and 60% post-operative improvement, respectively; (4) Conclusions: All studies showed improvement in post-operative functional outcomes and report no serious adverse events. The 6 mm, LARS (Orthomedic Ltd., Dollard-des-Ormeaux, QC, Canada) proved to have the most improvement in post-operative outcomes when used as a double bundle graft.
Topics: Humans; Patellofemoral Joint; Joint Instability; Knee Joint; Patellar Dislocation; Ligaments, Articular
PubMed: 38132916
DOI: 10.3390/medsci11040075 -
A Word of Caution for Future Studies in Patellofemoral Pain: A Systematic Review With Meta-analysis.The American Journal of Sports Medicine Feb 2021Patellar maltracking is widely accepted as an underlying mechanism of patellofemoral pain. However, methodological differences in the literature hinder our ability to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patellar maltracking is widely accepted as an underlying mechanism of patellofemoral pain. However, methodological differences in the literature hinder our ability to generate a universal quantitative definition of pathological patellofemoral kinematics (patellar maltracking) in patellofemoral pain, leaving us unable to determine the cause of patellofemoral pain.
PURPOSE
To systematically review the literature to provide evidence regarding the influence of confounding variables on patellofemoral kinematics.
STUDY DESIGN
Systematic review and random effects meta-analysis of control-case studies.
METHODS
A literature search of case-control studies that evaluated patellofemoral kinematics at or near full extension and were written in English was conducted using Embase, PubMed, Scopus, and Web of Science up to September 2019. Cases were defined as patients with patellofemoral pain. Studies were eliminated if they lacked quantitative findings; had a primary aim to assess therapy efficacy; or included participants with osteoarthritis and/or previous trauma, pathology, or surgery. A quality assessment checklist was employed to evaluate each study. Meta-analyses were conducted to determine the influence of confounding variables on measures of patellofemoral kinematics.
RESULTS
Forty studies met the selection criteria, with quality scores ranging from 13% to 81%. Patient characteristics, data acquisition, and measurement methods were the primary sources of methodological variability. Active quadriceps significantly increased lateral shift (standardized mean difference [SMD] = 0.33; = .0102) and lateral tilt (SMD = 0.43; = .006) maltracking. Individuals with pain secondary to dislocation had greater effect sizes for lateral maltracking than had those with isolated patellofemoral pain (ΔSMD = 0.71, = .0071; ΔSMD = 1.38, = .0055).
CONCLUSION
This review exposed large methodological variability across the literature, which not only hinders the generalization of results, but ultimately mitigates our understanding of the underlying mechanism of patellofemoral pain. Although our meta-analyses support the diagnostic value of maltracking in patellofemoral pain, the numerous distinct methods for measuring maltracking and the limited control for cofounding variables across the literature prohibit defining a single quantitative profile. Compliance with specific standards for anatomic and outcome measures must be addressed by the scientific and clinical community to establish methodological uniformity in this field.
Topics: Biomechanical Phenomena; Case-Control Studies; Humans; Joint Dislocations; Patella; Patellofemoral Joint; Patellofemoral Pain Syndrome; Quadriceps Muscle
PubMed: 32816535
DOI: 10.1177/0363546520926448 -
Journal of Orthopaedics and... Aug 2022This systematic review investigates the role of synthetic graft for primary medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent...
BACKGROUND
This systematic review investigates the role of synthetic graft for primary medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent patellofemoral instability, focusing on clinical scores and the rate of complications.
METHODS
This systematic review was conducted according to the PRISMA statement. The main online databases were accessed in January 2022 without time constraints. All clinical studies investigating the use of synthetic grafts for MPFL reconstruction were accessed. Revision settings were not considered. Only articles reporting data on patients with recurrent patellofemoral instability were eligible. Studies regarding congenital or acute patellofemoral dislocation were excluded. Only studies performing a follow-up longer than 24 months were considered.
RESULTS
Data on 199 patients [mean age 22.3 (range 19.0-28.0) years] were collected. The mean follow-up was 60.5 (39.0-142.8) months. All the scores of interest improved at last follow-up: Kujala (+ 24.8; P = 0.0002), Lysholm (+ 42.0; P = 0.02), Tegner (+ 1.2; P = 0.03), IKDC (+ 20.9; P = 0.02). Post-operatively, a positive apprehension test was detected in 6.1% (7/115) of patients, and a sensation of instability was reported by 1.5% (3/199) of patients. The rate of re-dislocations was 2.5% (5 of 199 patients), and revision procedures were performed in less than 1% (1 of 199) of patients.
CONCLUSION
Synthetic graft may be reliable and feasible for primary MPFL reconstruction in patients with recurrent patellofemoral instability.
Topics: Adult; Humans; Joint Dislocations; Joint Instability; Knee Joint; Ligaments, Articular; Patellar Dislocation; Plastic Surgery Procedures; Young Adult
PubMed: 35996063
DOI: 10.1186/s10195-022-00660-9 -
Archives of Orthopaedic and Trauma... Sep 2020There is still a lack of evidence concerning the patellar fixation of the medial patellofemoral ligament (MPFL) graft in selected patient with recurrent instability. The...
Patellar fixation graft via suture anchors versus tunnel techniques during isolated MPFL reconstruction for recurrent patellofemoral instability: a systematic review of the literature.
INTRODUCTION
There is still a lack of evidence concerning the patellar fixation of the medial patellofemoral ligament (MPFL) graft in selected patient with recurrent instability. The purpose of the present study was to investigate and compare clinical outcomes and further complications of isolated MPFL reconstruction via suture anchors versus tunnel techniques for recurrent patellofemoral instability.
MATERIALS AND METHODS
This systematic review of the literature was conducted according to the PRISMA guidelines. In September 2019, the main databases were accessed. All the clinical trials performing isolated MPFL reconstruction in patients with recurrent patellofemoral instability were included in the present study. Only articles fixing the MPFL graft through suture anchors and/ or patellar tunnel techniques were included in the analysis.
RESULTS
Data from 46 papers (1712 patients) were recorded. The mean follow-up was 40 ± 18 months. No differences were found in Kujala, Lysholm and Tegner score, International Knee Documentation Committee, visual analogic scale, range of motion and re-dislocation rate. The suture anchors fixation group detected reduced rate of apprehension test (OR: 0.6; p = 0.03), revision surgeries (OR: 0.4; p = 0.02) and anterior knee pain (OR: 0.05; p < 0.0001) and reduced not-classified complications (OR: 0.18; p < 0.0001).
CONCLUSION
Both the suture anchors and the bone-tunnels are a feasible option for isolated MPFL reconstruction in patients with recurrent patellofemoral instability. Patellar fixation via suture anchors evidenced a reduced rate of anterior knee pain, revision surgeries, apprehension test and an overall reduced complication compared to the bone-tunnel technique.
Topics: Humans; Joint Instability; Ligaments, Articular; Patella; Plastic Surgery Procedures; Suture Anchors
PubMed: 32318817
DOI: 10.1007/s00402-020-03420-8