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Reconstruction of the medial patellotibial ligament results in favorable clinical outcomes: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The medial patellotibial ligament (MPTL), the medial patellofemoral ligament (MPFL), and the medial patellomeniscal ligament (MPML) support the stability of the patellofemoral joint. The purpose of this systematic review was to report the surgical techniques and clinical outcomes of the repair or reconstruction of the MPTL in isolation or concomitant with the MPFL and/or other procedures.

Methods

A systematic review of the literature was conducted. Inclusion criteria were articles in the English language that reported clinical outcomes of the reconstruction of the MPTL in isolation or in combination with the MPFL and/or other procedures. Included articles were then cross-referenced to find additional journal articles not found in the initial search. The methodological quality of the articles was determined using the Coleman Methodology Score.

Results

Nineteen articles were included detailing the clinical outcomes of 403 knees. The surgical procedures described included hamstrings tenodesis with or without other major procedures, medial transfer of the medial patellar tendon with or without other major procedures and the reconstruction of the MPTL in association with the MPFL. Overall, good and excellent outcomes were achieved in > 75% of cohorts in most studies and redislocations were < 10%, with or without the association of the MPFL. An exception was one study that reported a high failure rate of 82%. Results were consistent across different techniques. The median CMS for the articles was 66 out of 100 (range 30–85).

Conclusion

Across different techniques, the outcomes are good with low rates of recurrence, with one article reporting a high rate of recurrence. Quality of the articles is variable, from low to high. Randomized control trials are needed for a better understanding of the indications, surgical techniques, and clinical outcomes. This systematic review suggests that the reconstruction of the MPTL leads to favorable clinical outcomes and supports the role of the procedure as a valid surgical patellar stabilization procedure.

Level of evidence

IV: systematic review of level I–IV studies.

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Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA

    Charles A. Baumann & Eli L. Pratte

  2. Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA

    Seth L. Sherman & Betina B. Hinckel

  3. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Elizabeth A. Arendt

Authors
  1. Charles A. Baumann
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  2. Eli L. Pratte
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  5. Betina B. Hinckel
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Contributions

CAB certifies that he had no conflicts of interest related to this study. ELP certifies that he had no conflicts of interest related to this study. SLS certifies that he had no conflicts of interest directly related to this study (see declaration of disclosure form for indirect activities outside the submitted work). EAA certifies that she had no conflicts of interest directly related to this study (see declaration of disclosure form for indirect activities outside the submitted work). BBH certifies that she had no conflicts of interest related to this study.

Corresponding author

Correspondence to Betina B. Hinckel.

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The authors of this study certify that they had no conflicts of interest directly related to this study (see individual declarations of disclosure for indirect activities outside the submitted work).

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This literature review involved the study of existing data, and approval from IRB was not applicable.

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This literature review involved the study of existing data, and informed consent was not applicable.

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Baumann, C.A., Pratte, E.L., Sherman, S.L. et al. Reconstruction of the medial patellotibial ligament results in favorable clinical outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc 26, 2920–2933 (2018). https://doi.org/10.1007/s00167-018-4833-6

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