Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy

Abstract

Purpose: We systematically reviewed the evaluated efficacy of medial patellofemoral ligament (MPFL) reconstruction, rehabilitation, and patient outcomes for safely returning patients to sports.

Methods: We performed a literature search using the Ovid Medline database from 1950 to present, as well as the SportDiscus and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Only English-language studies that described MPFL reconstruction or repair, rehabilitation, and patient outcome information were included. Search terms were combinations of "MPFL repair," "MPFL reconstruction," "patellofemoral ligament," "patellar dislocation," "patient outcome," and "rehabilitation." Coleman Methodology Scores were used to evaluate research quality.

Results: A total of 21 studies (11 prospective and 10 retrospective) met our inclusion criteria, with a total of 488 patients (184 male and 304 female patients) and 510 knees contributing to this review. Most patients were female (62.3%), and the mean age at surgery was 23.4 years (range, 6 to 52 years). Semitendinosus autografts were most commonly used (n = 145 [28.4%]). Of all reported complications at follow-up (n = 155), quadriceps dysfunction (n = 48 [31.0%]), positive apprehension (n = 32 [20.6%]), and decreased knee range of motion (n = 28 [18.1%]) were most common. Although inclusion criteria required rehabilitation information, the level of description was generally limited to acute care rehabilitation, with insufficient progressive exercise descriptions. Coleman Methodology Scores (58.76 ± 8.6) indicated generally poor study methodologies.

Conclusions: MPFL reconstruction and rehabilitation are likely to improve a patient's ability to perform activities of daily living. Poor study methodology including outcome surveys that lack either sensitivity or validity to measure the influence of patellofemoral joint dysfunction on sports participation, as well as limited exercise rehabilitation information, make it difficult to determine efficacy. Recommendations for improved outcome measurements and more comprehensive functional rehabilitation are provided.

Level of evidence: Level IV, systematic review.