Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review

It has been suggested that in the majority of patellar dislocation cases the medial patellofemoral ligament (MPFL) is disrupted. Accordingly several authors over the past decade have recommended repair or reconstruction of the MPFL to reduce the high incidence of recurrent dislocation. The purpose of this review was to determine whether MPFL reconstruction is a suitable procedure with regards to clinical and radiological outcomes for patients with patellar instability. A literature search using the electronic databases AMED, British Nursing Index, CINAHL, the Cochrane database, EMBASE, ovid Medline, Physiotherapy Evidence Database (PEDro), PsycINFO, Pubmed and Zetoc were performed from their inception to May 2007. All English language, human subject clinical papers reporting outcomes following MPFL reconstruction were included. Eight papers, collectively assessing 186 MPFL reconstructions, were finally included for review. Three reviewers independently assessed the methodological quality of each of the studies using the CASP appraisal tool. When analysed, it would appear that MPFL reconstruction may provide favourable clinical and radiological outcomes for patellar instability patients. However, following a critical appraisal of these papers a number of methodological weaknesses were identified including recruiting small samples, not controlling for confounding variables, and providing limited statistical analysis of results. Future study is recommended to address these methodological flaws, in addition to beginning to assess the effectiveness of this procedure, in different patient groups.