Lateral retinacular release combined with MPFL reconstruction for patellofemoral instability: a systematic review
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ARTHROSCOPY AND SPORTS MEDICINE
Lateral retinacular release combined with MPFL reconstruction for patellofemoral instability: a systematic review Filippo Migliorini1 · Nicola Maffulli2,3,4 · Jörg Eschweiler1 · Valentin Quack1 · Markus Tingart1 · Arne Driessen1 Received: 21 December 2019 / Accepted: 11 November 2020 © The Author(s) 2020
Abstract Introduction The role of the lateral retinaculum in patellofemoral instability is still debated. Lateral retinacular release (LRR), has been extensively performed in combination with different surgical procedures, including reconstruction of medio-patellofemoral ligament (MPFL). Despite controversial indications, the results from these studies seem promising. The present study conducts a systematic review about current biomechanical and clinical evidence concerning the role of LRR in combination with MPFL reconstruction. We performed a comprehensive literature research, comparing the outcomes of MPFL reconstruction with and without LRR. Materials and methods This systematic review was conducted according to the PRISMA guidelines. The literature search was performed in August 2020. All articles describing the outcome of isolated MPFL reconstruction alone or in combination with a LRR in patients with recurrent patellofemoral instability were considered for inclusion. Only articles reporting data on patients with a minimum of 12-month follow-up were included. Only articles reporting quantitative data under the outcomes of interest were included. Results A total of 63 articles were eligible for this systematic review, including 2131 knees. The mean follow-up was 40.87 ± 24.1 months. All scores of interests improved in favour of the combined group: Kujala + 3.8% (P = 0.01), Lysholm + 4.2% (P = 0.004), Tegner + 0.8 points (P = 0.04), IKDC + 9.8% (P = 0.02). The ROM was comparable between the two groups (P = 0.4). Similarity was found in terms of positivity to the apprehension test (P = 0.05), rate of complications (P = 0.1), re-dislocations (P = 0.8), and revision surgeries (P = 0.1). Conclusion There is no evidence that adding a lateral release impacts positively on the outcome of MPFL reconstruction. Level of evidence: IV, Systematic review Keywords Patellofermoral instability · Dislocations · MPFL reconstruction · Lateral retinacular release
Introduction * Filippo Migliorini [email protected] 1
Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
2
Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy
3
School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England
4
Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England
Patellofemoral instability is a complex disorder with higher prevalence in young and active individuals [1,
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