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Table 1 Clinical results of MPTL and MPFL reconstructions

From: Combined medial patellofemoral and medial patellotibial reconstruction for patellar instability: a PRISMA systematic review

References N Follow-up (mean) Indications Graft/technique Associated risk factors Results
Ebied and El-Kholy [12] 25 34 months - At least 1 dislocation or subluxation
- Persistent symptoms of instability despite 2 weeks of rehabilitation
ST and GT with distal insertion maintained
One tunnel in the patella
Lateral retinaculum release in 68% TTO in 32%
Trochlear dysplasia with:
- Mean sulcus angle 141°
Patella alta: not mentioned
Lateral quadriceps vector: mean TTTG 15 mm
Results: 76% excellent, 20% good, and 4% fair
IKDC scores: 54–81
Effusion of the knee: 8%
Brown and Ahmad [13] 2 14 months Dislocation with normal osseous anatomy and mechanical alignment ST and GT Distal insertion maintained
Docking tunnel in the patella
No risk factors Redislocation: none
Kujala scores: 43–88 in 1 patient; 50–98 in 2 patients
Lysholm scores: 38–97 in 1 patient 1; 55–95 in 2 patients
Sobhy et al. [20] 29 32.2 months Recurrent dislocation with normal patellofemoral bone morphology and limb alignment with no other ligamentous deficiencies ST and GT with distal insertion maintained
Two tunnels in the patella
No risk factors Redislocation: none
Returned to previous level of activity:96.4%
Kujala scores: 36.6–90.6
Lysholm scores: 51.9–89.5
VAS mean 6.3–1.8
Cincinnati scores: 50–88
Congruence angle: 11.93°–6.48°
Patellar tilt: 10.9°–2.45°
Subjective instability: 6.9%
Hinckel et al. [22] 7 5.5 months Recurrent patellar dislocation with:
- Subluxation in extension
- Instability in flexion
- Hyperextension of the knee with ligament laxity
- Open growth plate with predisposing factors (increased lateral quadriceps vector, patella alta and trochlear dysplasia)
Medial quadriceps for the MPFL and medial patellar tendon for the MPTL
Lateral retinaculum release in 42.9%. Shortening of the patellar tendon in 14.3%
Trochlear dysplasia with:
- Modified Dejour classification: A (57.1%), B (14.3%), C (14.3%) and D (14.3%)
Patella alta: CD > 1.2 (71.4%)
Lateral quadriceps vector: TTTG > 20 mm (42.9%)
Lengthening of the quadriceps tendon: 14.3%
Redislocation: none
Satisfaction 9/10: 71.4%
Wound dehiscence: 14.3%
Drez et al. [27] 15 31.5 months - Recurrent instability after failed non-operative measures
- Patients with patellar instability and a loose osteochondral fragment following patellar dislocation
ST (6 knees), ST + GT (5 knees), and Iliotibial band (3 knees). All as free grafts, one repair - Trochlear dysplasia: not mentioned
- Patella alta: normal
- Lateral quadriceps vector: Q angle < 15°
Redislocation: none
Results: 93% excellent and good.
Fulkerson score mean: 93.
Kujala score mean: 88.6.
Congruence angle: 25.3°–5.5°.
Arthrofibrosis: 6.7%.
Quadriceps atrophy: 60%.
Yang and Zhang [28] 58 24 months - At least two lateral patellar dislocations
- Failure of a nonoperative treatment programme
- 18 years at the time of surgery
ST with distal insertion maintained and fixed to tibial periosteum
Proximal end fixed at the origin of the naïve MPFL in the medial aspect of the femur
- TT–TG distance > 20 mm
- Grade of trochlear dysplasia
- Patella alta: by Insall–Salvati ratio criteria
Results: 87.9% excellent, 6.9% good, 3.4% fair, 1.7% poor.
Kujala score: 89.5 ± 10.2
IKDC score: 85 ± 13.9
VAS: 11 ± 4
Patellar tilt: 113 ± 5.2
Insall–Salvati ratio: 1.37 ± 0.19
Modified Insall–Salvati ratio: 1.95 ± 0.25
TT–TG distance: 19.9 ± 1.7
Caton–Deschamps Index: 1.31 ± 0.17
Sadigursky et al. [29] 7 12 months - More than two episodes of patellar dislocation
- MRI demonstrating extensive rupture of the medial retinaculum were included
ST with distal insertion maintained fixed with a metallic anchor inserted into the tibia
The graft is percutaneously transferred to medial edge of the patella and fixated by a metal anchor
And passed to the femur it is fixed by the fourth anchor in the Schöttle point
- Patellar height: Caton-Deschamps
- Trochlear dysplasia
- TT–TG distance
Kujala score: 88.57 ± 5.09
Lysholm score: 87.71 ± 5.70
Hetsroni et al. [30] 20 43 months - History of recurrent lateral patellar instability
- Physis closure
- Patella which could be dislocable under anaesthesia
GT or ST with distal insertion maintained. Docking tunnel in the patella. it is fixed by the anchor in a mid-point between medial epicondyle and adductor tubercle - BMI
- Beighton score
- TT–TG distance in the range (10–18 mm)
- no cases of significant trochlea dysplasia or patella alta
Kujala score: 86.4 ± 12.5
Tegner score: 4.8 ± 2.4
Maffulli et al. [37] 34 3.1 years - Two documented episodes of unilateral patellar dislocation necessitating reduction confirmed radiographically.
- All patients undertaken intensive rehabilitation for 3 to 6 months after each documented episode of dislocation
Combined reconstruction of MPFL and MPTL using an ipsilateral autologous GT, passed into two patella tunnels, looped and sutured on the adductors magnus tendon No risk factors Cincinnati Score increase to 90 ± 19 (p < 0.001)
Kajala score increase to 82 ± 17 (p < 0.02)
Insall-Salvati index remain within normal range
No difference between males and females
No difference with or without osteochondral lesions