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      Does medial patellofemoral ligament reconstruction result in femoral tunnel enlargement? A systematic review

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          Abstract

          Background

          Medial patellofemoral ligament (MPFL) reconstruction is a common surgical procedure for treating patellar instability. The primary aim of this systematic review was to determine whether MPFL reconstruction (MPFLR) leads to femoral tunnel enlargement (FTE). The secondary aims were to explore the clinical effects and risk factors of FTE. Electronic databases (MEDLINE, Global Health, Embase), currently registered studies, conference proceedings and the reference lists of included studies were searched independently by three reviewers. There were no constraints based on language or publication status. Study quality assessment was conducted. 3824 records were screened in the initial search. Seven studies satisfied the inclusion criteria, evaluating 380 knees in 365 patients. Rates of FTE following MPFLR ranged from 38.7 to 77.1%. Five low quality studies reported FTE did not lead to detrimental clinical outcomes as assessed with the Tegner, Kujala, IKDC, and Lysholm scores. There is conflicting evidence regarding change in femoral tunnel width over time. Three studies (of which two had a high risk of bias) reported age, BMI, presence of trochlear dysplasia and tibial tubercle-tibial groove distance did not differ between patients with and without FTE, suggesting these are not risk factors for FTE.

          Conclusion

          FTE is a common postoperative event following MPFLR. It does not predispose poor clinical outcomes. Current evidence lacks the ability to identify its risk factors. The reliability of any conclusions drawn is hindered by the low level of evidence of the studies included in this review. Larger prospective studies with long-term follow up are required to reliably ascertain the clinical effects of FTE.

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          Most cited references28

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

            Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.
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              Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction.

              Reconstruction of the medial patellofemoral ligament has recently become popular for restoring patellofemoral stability. Femoral insertion site anatomy of the medial patellofemoral ligament has been described. This anatomical insertion has been inferred to be the isometric point in medial patellofemoral ligament reconstruction, but data about radiographic landmarks for a postoperative or intraoperative control are missing. To determine the radiographic landmarks for control of postoperative and intraoperative femoral medial patellofemoral ligament insertion. Descriptive laboratory study. Eight fresh-frozen human knees were dissected, and the medial patellofemoral ligament was exposed. After identification of the femoral medial patellofemoral ligament insertion site, the insertion center was marked with a lead ball of 2-mm diameter. Straight lateral radiographs were taken, and posterior-anterior as well as proximal-distal position were evaluated. Six of 8 insertion points were anterior to a line representing an extension of the posterior cortex, 1 point was touching this line, and 1 point was posterior to it. All points were situated distal to the posterior origin of the medial femoral condyle and proximal to the most posterior point of the Blumensaat line. A reproducible anatomical and radiographic point, 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of the Blumensaat line on a lateral radiograph with both posterior condyles projected in the same plane, shows the mean femoral medial patellofemoral ligament center. This radiographic point may be useful both intraoperatively and postoperatively.
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                Author and article information

                Contributors
                m1800817@sgul.ac.uk
                Journal
                Knee Surg Relat Res
                Knee Surg Relat Res
                Knee Surgery & Related Research
                BioMed Central (London )
                2234-0726
                2234-2451
                2 May 2023
                2 May 2023
                2023
                : 35
                : 13
                Affiliations
                [1 ]GRID grid.264200.2, ISNI 0000 0000 8546 682X, St George’s University Hospitals NHS Foundation Trust, St George’s University London, ; London, UK
                [2 ]GRID grid.7372.1, ISNI 0000 0000 8809 1613, Warwick Medical School, University of Warwick, ; Coventry, UK
                [3 ]GRID grid.411616.5, ISNI 0000 0004 0400 7277, Department of Trauma and Orthopaedics, , Croydon University Hospital, ; London, UK
                [4 ]GRID grid.451349.e, Department of Trauma and Orthopaedics, , St George’s University Hospitals NHS Foundation Trust, ; London, UK
                Author information
                http://orcid.org/0000-0002-1901-8214
                Article
                187
                10.1186/s43019-023-00187-1
                10152597
                37131234
                b425ca31-6688-4e2a-ba5a-ed6655b0c28a
                © The Author(s) 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 1 January 2023
                : 18 April 2023
                Categories
                Review Article
                Custom metadata
                © The Author(s) 2023

                Surgery
                medial patellofemoral ligament reconstruction,femoral tunnel widening,clinical outcomes,risk factors,systematic review

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