Medial patellofemoral ligament reconstruction using synthetic suture tape: A systematic review of biomechanical and clinical outcomes.

Abstract

Purpose: To review outcomes of medial patellofemoral ligament reconstruction (MPFLR) using synthetic suture tape in biomechanical and clinical studies.

Methods: A comprehensive literature search was performed in three databases. Studies reporting biomechanical and/or clinical outcomes of MPFLR using synthetic suture tape were included. For clinical studies, the primary outcome measures included patient-reported outcomes (PROs) and adverse events.

Results: Three biomechanical studies were included. One study reported stronger integrity of fixation with suture tape versus semitendinosus autografts. One study reported similar integrity of MPFLR with knotless anchor versus soft tissue fixation. Another study found suture tape fixation between 60° and 90° of knee flexion to avoid excessive medial patellofemoral joint contact pressure after MPFLR. Eight clinical studies with 287 patients and 317 knees (36.1 % male, pooled mean age: 23.2 years old, pooled mean follow-up: 41.6 months) were included. All studies reported significant preoperative to postoperative improvement for all PROs except for the Tegner score in one study. The range of PROs were as follows (preoperative and postoperative): Lysholm (32.8-72.0 and 78.0 to 96.7), Kujala (36.0-75.2 and 78.8 to 97.7), International Knee Documentation Committee (IKDC) (48.6-69.8 and 71.3 to 91.3), and Tegner (1.0-4.6 and 4.0 to 6.5). Two studies comparing suture tape with autografts (quadriceps and gracillis tendons) reported similar postoperative PROs. The pooled rate of adverse postoperative events was 8.2 %. The pooled rate of positive patellar apprehension tests at follow-up was 3.2 %.

Conclusions: Patients undergoing MPFLR with suture tape fixation achieved significant improvements in PROs and demonstrated low rates of postoperative complications. Compared to autograft fixation, suture tape fixation provided comparable or superior clinical and biomechanical outcomes.