The efficacy of medial patellofemoral ligament reconstruction combined with distal femoral varus osteotomy in recurrent patellar dislocation and genu valgum.

Medial patellofemoral ligament (MPFL) reconstruction is a widely recognized treatment for recurrent patellar dislocation. However, limited research addresses the outcomes of combining MPFL reconstruction with distal femoral varus osteotomy, particularly in patients with genu valgum. This study aims to evaluate the clinical outcomes of this combined surgical approach in individuals experiencing recurrent patellar dislocation associated with genu valgum. A systematic review followed PRISMA guidelines by searching the PubMed, Scopus, and Cochrane Library databases through July 1, 2024. Studies included patients whose MPFL reconstruction was combined with distal femoral varus osteotomy to treat recurrent patellar dislocation and genu valgum. A meta-analysis was performed to evaluate pain, clinical and functional outcomes, with data reported as mean difference (MD) and 95% confidence interval (CI). A total of three studies with 58 knees were included. Most of the patients were female 62.5%, with a mean patient age of 20.5 years and a mean follow-up of 26.4 months. The mean preoperative mechanical leg axis was 6.8° of valgus. After MPFL reconstruction with distal femoral varus osteotomy significant improvements were found in the Kujala score (MD, 33.64 [95% CI 31.3-35.99]), Lysholm score (MD, 34.89 [95% CI 23.27-46.51]), visual analog scale score for pain (MD, - 3.99 [95% CI - 5.66 to - 2.31]), and Tegner Activity Score (MD, 1.96 [95% CI 1.63-2.29]). No subluxation or redislocation occurred in any study during the follow-up period, and all reported radiological correction of genu valgum. Combined medial patellofemoral ligament reconstruction and distal femoral varus osteotomy in patients with recurrent patellar dislocation and genu valgum lead to significant improvements in clinical outcomes, such as pain relief and functional scores, as well as effective radiological correction of valgus deformity. However, further high-quality studies are needed to confirm these findings and establish stronger evidence for this combined approach. Systematic review and meta-analysis, level IV.