Summary

This systematic review and meta-analysis explored the efficacy of MPFL repair versus nonoperative treatment on the rate of patellar redislocations and functional outcomes in patients with acute first-time patellar dislocations. Early MPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferior complication rates compared to nonoperative treatment.

Abstract

Purpose

This study aimed to explore the efficacy of early medial patellofemoral ligament (MPFL) repair versus nonoperative rehabilitation treatment on the rate of patellar redislocation and functional outcomes in skeletally mature patients with traumatic, first-time patellar dislocations.

Methods

MEDLINE, PubMed and EMBASE were searched from database inception to May 2022 for studies examining the management options for acute first-time patellar dislocations. This study was conducted in accordance with PRISMA and R-AMSTAR guidelines. Data on redislocation rates, functional outcomes including the Kujala score for anterior knee pain, and complication rates were extracted. A meta-analysis was used to pool the mean postoperative Kujala score and calculate the proportion of patients sustaining redislocations using a random effects model. Quality assessment of included studies was performed for all included studies using the MINORS and Detsky scores.

Results

This review included a total of 25 studies and 1361 patients. The pooled mean redislocation rate in 15 studies comprising 798 patients in the rehabilitation group was 30% (95% CI 25%-36%, I2 = 65%). Moreover, the pooled mean redislocation rate in 10 studies comprising 170 patients undergoing early MPFL repair was 7% (95% CI 3%-12%, I2 = 30%). The pooled mean postoperative Kujala anterior knee pain score in 8 studies comprising 396 patients in the rehabilitation group was 82.5 (95% CI 78.3-86.8, I2 = 91%), compared to a score of 88 (95% CI 87-90, I2 = 76%) in 3 studies comprising 94 patients in the repair group. Range of motion deficits were reported in 3.8% of 893 patients in the rehabilitation group and 2.0% of 205 patients in the repair group.

Conclusion

MPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferiority with respect to range of motion deficits compared to nonoperative treatment for the management of acute first-time patellar dislocations. The paucity of high-level evidence warrants further investigation in this topic in the form of well-designed and high-powered RCTs to determine the optimal management of these patients.