Abstract
Background:
The medial patellofemoral ligament (MPFL) serves as a major stabilizer in the knee, providing restraint against lateral patellar translation. The optimal approach for managing patients with first-time MPFL injuries remains uncertain, as the choice between operative and non-operative treatment depends on the risks and variability associated with individual patient anatomy, activity, and presentation. The purpose of this study is to evaluate high-level literature on outcomes following operative and non-operative treatment of MPFL injuries to guide decision-making.
Objectives:
Operative treatment of MPFL injuries leads to a significantly lower rate of recurrent instability compared to non-operative treatment.
Methods:
This systematic review and meta-analysis utilized PubMed, CINAHL, MEDLINE, Web of Science, and SPORTDiscus through November 25th, 2024, to find RCTs which assess the outcomes associated with operative versus non-operative treatment for MPFL tears. The primary outcomes were rates of recurrent dislocation and patient reported outcomes. Statistical analysis included relative risk (RR) with 95% confidence intervals (CI) along with trial sequential analysis (TSA) and assessment of fragility index (FI).
Results:
A total of 306 patients (55.9% female) had a frequency-weighted mean age of 19.68 ± 4.24 years (range 9-40) and a frequency-weighted mean follow-up time of 21.61 ± 5.34 months and underwent non-operative (n=147) or operative (n=159) treatment.
Conclusion:
Operative treatment of MPFL injuries resulted in a robust and statistically significant lower rate of recurrent instability compared to non-operative treatment, though there was no difference in Kujala scores. The key to these findings is the need for further studies to draw more definitive conclusions as TSA showed that the current level of evidence is insufficient to draw definitive conclusions.