Females Experience Higher Rates of Recurrent Dislocation Following Medial Patellofemoral Ligament Reconstruction: A Systematic Review.

PURPOSE: To perform a systematic review to investigate and summarize the literature regarding the influence of sex on postoperative outcomes following primary medial patellofemoral ligament (MPFL) reconstruction, with a primary focus on MPFL failure and recurrent dislocation, and a secondary analysis of postoperative patient-reported outcome measures (PROMs).

METHODS

A literature review was performed using the PubMed, Scopus, and Web of Science databases. Included were randomized controlled trials or cohort studies that provided sex-stratified, quantitative analysis of MPFL reconstruction outcomes. Studies were excluded if they were biomechanical studies, cadaveric studies, Level of Evidence IV or V studies, or articles not published in English. The primary outcome of interest was postoperative failure, specifically recurrent dislocation, with the secondary outcome being PROMs.

RESULTS

Eleven studies met inclusion criteria on 903 patients: 292 males (32%) and 611 females (68%). Overall, 17 of 611 females experienced postoperative dislocations, while 1 of 292 males reported a postoperative dislocation. Three studies did not record any postoperative recurrent dislocations for either sex. The Kujala questionnaire PROM was quantitatively reported in 4 studies, with postoperative averages ranging from 87.7 to 95.3 for males compared to 80.2 to 89.0 for female patients.

CONCLUSIONS

Based on this systematic review, females experienced higher rates of recurrent dislocation and recorded worse PROMs following MPFL reconstruction.

LEVEL OF EVIDENCE: Level III, systematic review of Level I to III studies.