Medial Patellofemoral Ligament Reconstruction Combined With Bony Procedures for Patellar Instability: Current Indications, Outcomes, and Complications

PURPOSE: The aim of this literature review is to analyze current indications, outcomes, and complication rates of medial patellofemoral ligament (MPFL) reconstruction associated with bony procedures in order to clarify efficacy and adoptability in selected patients with patellar instability.METHODS: A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases was performed, using various combinations of the keywords patellar instability, MPFL reconstruction, tibial tubercle osteotomy, and trochleoplasty.RESULTS: Fourteen of 501 articles were included. Indications for surgery included dysplasia and malalignment. All studies reported significant improvements in overall clinical outcomes. The most frequently used score was the Kujala score, with a mean value of 83.26. Functional failures ranged from 0% to 8.8%. Major complications were not described. Minor complications ranged from 0% to 40%. Reoperations ranged from 4.5% to 17.7%.CONCLUSIONS: A combined approach seems indicated in patients with patellar instability, especially among those with high tibial tuberosity-trochlear groove or severe trochlea dysplasia. Indications for combined MPFL and bony procedure are influenced by anatomy, including dysplasia and malalignment. We are unable to identify an absolute indication. Bony procedures are associated with increased morbidity.LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.