Stiffness and Instability After MPFL Reconstruction Using a Fluoroscopic Versus Open Technique to Localize the Femoral Attachment Site: A Systematic Review and Meta-analysis

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2023 Jun 21

PMID 37342554

Authors

Koan Heindel

Jason Smoak

Joseph Kocan

Charles Cossell

Mohammad Nadir Haider

Benjamin J Levy

Leslie Bisson

Affiliations

Soon will be listed here.

Abstract

Background: Open and fluoroscopic techniques have been described for localization of the femoral attachment site in medial patellofemoral ligament (MPFL) reconstruction. No study to date has evaluated if one technique is superior to another in terms of complications.

Purpose: To review the literature comparing clinical outcomes of MPFL reconstruction using the fluoroscopic versus open technique to localize the site of femoral graft placement.

Study Design: Systematic review; Level of evidence, 4.

Methods: A systematic literature review was performed via PubMed, Embase, and CINAHL to identify articles published between the inception of these databases and March 1, 2022, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This search yielded 4183 publications for initial review. Studies with at least a 2-year follow-up and complete reporting of patient-reported outcomes, range of motion, recurrent instability, and/or complications (ie, stiffness, infection, persistent pain) were included. We excluded studies of patients with collagen disorders; revision surgeries; surgeries with concomitant procedures; synthetic MPFL reconstruction; MPFL repairs; combined open and radiographic technique; and case series that included <10 patients. A proportional meta-analysis was performed by calculating the pooled estimate of incidence with 95% CIs using a fixed-effects model with double arcsine transformation (Freeman-Tukey) for each type of surgical technique (fluoroscopic or open).

Results: A total of 29 studies met our inclusion criteria, of which 15 studies (566 patients) used the open technique and 14 studies (620 patients) used fluoroscopy. There were no significant differences between the open and fluoroscopic techniques in the incidence of postoperative apprehension ( = .4826), postoperative subjective instability ( = .1095), postoperative objective instability ( = .5583), reoperations ( = .7981), recurrent dislocation ( = .6690), or arthrofibrosis ( = .8118).

Conclusion: Both open and radiographic localization of the femoral graft position in MPFL reconstruction offer similar outcomes and rates of complications.

Citing Articles

Comparison of five different fluoroscopic methods for identifying the MPFL femoral footprint.

Emre T, Cetin H, Selcuk H, Kilic K, Aykanat F, Sarikcioglu L Arch Orthop Trauma Surg. 2024; 144(4):1675-1684.

PMID: 38400901 PMC: 10965741. DOI: 10.1007/s00402-024-05213-9.

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