Archives of Orthopaedic and Trauma Surgery - 2026-08-03 - Journal Article; Systematic Review; Meta-Analysis; Review
The incidence and epidemiology of patellar fractures following medial patellofemoral ligament reconstruction: a systematic review and meta-analysis.
Abelleyra Lastoria DA, Hunt A, Ross CK, Yemane M, Keynes S, Ghosh A, Hing CB
Topics
Key Takeaway
Patellar fracture occurs at a pooled incidence of 1.17% (95% CI 0.76–1.68%) following MPFL reconstruction across 115,496 patients, with no significant difference between tunnel versus non-tunnel fixation techniques.
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Summary
This PROSPERO-registered systematic review and random-effects meta-analysis quantified the incidence of and risk factors for patellar fracture after MPFL reconstruction. Pooled fracture incidence was 1.17% (95% CI 0.76–1.68%), ranging from 0 to 9.50% across included studies. Bone tunnel fixation (0.94%) versus non-tunnel fixation (1.00%) and concomitant procedures (1.26%) versus MPFLR alone (0.53%) showed no statistically significant difference in fracture rates.
Key Limitation
The moderate-to-low quality of included evidence and likely heterogeneity in tunnel placement, graft tensioning, and rehabilitation protocols across 110 studies prevents meaningful technical subgroup conclusions.
Original Abstract
INTRODUCTION
Patellar instability can arise from a traumatic event with anatomical predisposing factors increasing the risk of dislocation. Medial patellofemoral ligament reconstruction (MPFLR) is commonly performed to treat patellar instability. The aim of this systematic review was to determine the incidence of and risk factors for patellar fractures after MPFLR.
MATERIALS AND METHODS
The protocol for this review was registered on PROSPERO with registration number CRD420251066107. The PRISMA 2020 checklist was followed. Electronic databases and conference proceedings were searched to the 15th of May 2025. Studies were eligible if they reported incidence of patellar fractures after MPFLR. A random-effects meta-analysis was performed. Included studies were appraised using tools respective of study design.
RESULTS
A total of 4,972 records were screened in the initial search. A total of 110 studies satisfied the inclusion criteria, evaluating 115,496 patients. The evidence was moderate to low in quality. The incidence of patellar fracture ranged from 0 to 9.50%, with a pooled incidence of 1.17% (95% confidence interval [CI] 0.76- 1.68%). There was no difference in incidence of patellar fractures between patients who did and did not undergo bone tunnel fixation (0.94%, 95% CI 0.69-1.24 vs. 1.00%, 95% CI 0.15-2.44%, respectively). There was no difference in fracture incidence between patients who underwent concomitant procedures (1.26%, 95% CI 0.51-2.32) and those who underwent MPFLR alone (0.53%, 95% CI 0.13-1.16%).
CONCLUSION
Patellar fractures are a known complication of MPFLR, with a higher incidence observed in patients undergoing this procedure compared to the baseline population risk. Current evidence suggests its incidence is not affected by tunnel location or the performance of concomitant procedures, though further prospective studies are required to corroborate this. Appropriate post-operative follow-up is required to monitor the occurrence of patellar fractures during the post-operative period.