title: Widespread Implementation of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Maintains Functional Outcomes at Midterm to Long-Term Follow-up While Decreasing Complication Rates: A Systematic Review.
abstract: OBJECTIVE
  Our primary purpose was to evaluate whether complications have increased or functional outcomes have changed as medial patellofemoral ligament (MPFL) reconstruction has been adopted by more surgeons at more institutions over recent years. Our secondary purpose was to further define the complication profile of MPFL reconstruction.
  
  
  METHODS
  A systematic review of the literature was performed on January 12, 2014, using the keywords "medial patellofemoral ligament reconstruction," "patellar instability reconstruction," "patellofemoral ligament reconstruction," and "MPFL." Articles meeting our inclusion criteria were reviewed. Outcome measures, functional failures, complications, graft choice, and surgical technique were recorded and analyzed.
  
  
  RESULTS
  Thirty-four articles met our exclusion and inclusion criteria and were reviewed. Nineteen articles were "new" additions to the literature, whereas 15 had previously been reported on in prior analyses ("old"). The 19 new articles reported a statistically significant decrease in functional failure rates, from 9.55% in older studies to 4.77% in more recent studies (P < .001). The major complication rate dropped from 2.01% to 0.46% in the newer studies (P = .005), and the minor complication rate decreased from 6.53% to 4.00% (P = .06). Postoperative Kujala scores did not show a statistically significant change between newer and older publications (89.0 [SD, 3.7] and 89.4 [SD, 4.9], respectively; P = .55). Comparing results by fixation type, as well as by graft choice, showed no statistically significant differences in terms of outcomes or complication profile.
  
  
  CONCLUSIONS
  With nearly twice the number of medical centers performing reconstruction of the MPFL and outcomes reported on nearly double the number of patients in recent years, functional outcomes remain favorable as complication and failure profiles are improving. Furthermore, despite a wide array of fixation techniques, as well as multiple options for graft constructs, there are no statistically or clinically significant differences in functional outcomes over time. This finding highlights the efficacy and adoptability of MPFL reconstruction for the treatment of recurrent patellar instability.
  
  
  METHODS
  Level IV, systematic review of mixed-level studies.
authors.affiliation: Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.. Electronic address: kstupay@tulane.edu.
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Stupay
authors.affiliation: Columbia University Medical Center, New York, New York, U.S.A.
authors.forename: Eric
authors.initials: E
authors.lastname: Swart
authors.affiliation: Department of Orthopaedic Surgery & Sports Medicine, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Beth E
authors.initials: BE
authors.lastname: Shubin Stein
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D057071:Patellofemoral Joint / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D016896:Treatment Outcome