Arthroscopy - 2026-08-13 - Journal Article; Review
Medial Quadriceps Tendon-Femoral Ligament Reconstruction Offers Favorable Clinical Outcomes and Low Complication Rates for Recurrent Patellar Instability: A Systematic Review.
Kahlon H, Blackman B, Vivekanantha P, Ranadive A, Bouchard MD, de Sa D, Kay J
Topics
Key Takeaway
Medial patellofemoral complex reconstruction (MQTFLR + MPFLR) achieves a 1.6% redislocation rate and 88.5–100% return to sport across 347 patients with recurrent patellar instability.
Summary Depth
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Summary
This systematic review evaluated clinical outcomes and complications of MQTFLR, isolated or combined with MPFLR (MPFCR), for recurrent patellar instability across 9 studies and 347 patients (mean age 18.6 years, 68.3% female). MPFCR achieved Kujala scores of 85.9–93.6, IKDC scores of 81.5–91.2, and MCID thresholds in 100% of knees for Kujala and 94.1% for IKDC. Isolated MQTFLR and isolated MPFLR showed comparable functional scores but higher complication rates including arthrofibrosis, flexion limitation, and patellar fracture compared to combined MPFCR.
Key Limitation
The systematic review is limited to Level III–IV studies with heterogeneous surgical techniques and variable follow-up durations, precluding definitive conclusions about superiority over isolated MPFLR.
Original Abstract
PURPOSE
To evaluate the surgical methods, clinical outcomes, and complication profile of patients undergoing medial quadriceps tendon-femoral ligament reconstruction (MQTFLR), either isolated or as medial patellofemoral complex reconstruction (MPFCR), for recurrent patellar instability.
METHODS
Three databases (PubMed, EMBASE, and MEDLINE) were searched on July 28, 2025, for clinical studies assessing patient outcomes following MQTFLR with or without concurrent medial patellofemoral ligament reconstruction (MPFLR). Data on functional outcomes including Kujala scores, International Knee Documentation Committee (IKDC) scores, Lysholm scores, Tegner score, and visual analog scale scores were collected, along with return to sport, redislocation rates, revisions, and other complications. The Methodological Index for Non-Randomized Studies criteria were used to assess study quality.
RESULTS
Nine studies comprising 347 patients (68.3% female, mean age 18.6 years (range: 12.2-29.0)) were included. Combined MQTFLR + MPFLR (MPFCR) showed favorable Kujala scores (range 85.9-93.6), IKDC scores (range 81.5-91.2), Lysholm scores (range 84.3-93.3), and moderate Tegner scores (4.6-6.0). Among MPFCR patients with available minimum clinically important difference data, the minimum clinically important difference was achieved in 61/61 knees (100%) for Kujala, 97/103 knees (94.1%) for IKDC, 60/61 knees (98.1%) for Lysholm, and 44/61 knees (72.1%) for Tegner. The IKDC patient acceptable symptom state score was surpassed by 28/42 knees (66.7%). Patients undergoing MPFCR were found to have a high return to sport rate (88.5%-100%) and a low redislocation rate (1.6%). The single major complication was arthrofibrosis in 2 patients. Isolated MQTFLR and isolated MPFLR both showed comparable functional outcomes, but a higher rate of complications such as arthrofibrosis, flexion limitation, and patellar fracture compared with patients who underwent MPFCR.
CONCLUSIONS
MQTFLR in combination with MPFLR (MPFCR) is a viable option for surgical management of patellofemoral instability, with favorable clinical outcomes supporting its use.
LEVEL OF EVIDENCE
Level IV, systematic review of Level III and IV studies.