Knee Flexion Angle During Graft Fixation for Medial Patellofemoral Ligament Reconstruction: A Systematic Review of Outcomes and Complications

Purpose: To determine the effect of knee flexion angle during graft fixation on outcomes and complications following medial patellofemoral ligament (MPFL)reconstruction. Methods: Three databases (PubMed, EMBASE, and MEDLINE)were searched from database inception to January 2018. After screening based on inclusion and exclusion criteria, patient demographics, fixation technique, graft selection, outcomes, and complications were extracted from the included studies. The studies were grouped based on flexion angle used during graft fixation: low (0°-30°)and high (45°-90°)flexion angle group. Methodological Index for Non-Randomized Studies criteria were used to assess the quality of each included study. Descriptive statistics are presented. Results: Seventeen studies (of 3,399)were included and were either cohort (n = 1)or case series (n = 17)study designs. A total of 556 patients with a mean age of 23.6 years (range, 10-60 years)underwent MPFL reconstructions, with 458 patients in the 0° to 30° fixation group and 98 in the 45° to 90° fixation group. The mean Kujala score improved from 45 to 72.9 (365 patients)preoperatively to 83 to 94.5 (460 patients)postoperatively for the 0° to 30° fixation group and from 53.3 to 72 preoperatively to 92.2 to 95.2 postoperatively for the 45° to 90° fixation group (98 patients). Conclusions: The knee flexion angle during MPFL graft fixation ranges from 20° to 90°. Graft fixation at low and high knee flexion angles during MPFL reconstruction showed excellent patient-reported outcomes and low patellar redislocation rates overall, with no clear differences between the 2 groups based on the currently available data. Level of Evidence: Level IV, systematic review of Level III-IV studies.