Medial patellofemoral ligament reconstruction after patellar instability: a systematic review of when and for whom to operate

Recurrent patellar dislocation is a common condition in adolescents and young adults, often associated with significant functional limitations. The medial patellofemoral ligament is the primary passive stabilizer against lateral patellar displacement, and its insufficiency plays a central role in instability. While surgical reconstruction has become the mainstay treatment for recurrent cases, the optimal indications and patient selection remain subjects of ongoing debate. This systematic review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Databases were searched for studies evaluating medial patellofemoral ligament reconstruction, with inclusion criteria focused on surgical indications, patient characteristics, clinical outcomes, and postoperative complications. Data on redislocation rates, functional scores, surgical techniques, and return-to-sport outcomes were extracted and qualitatively synthesized. Across the included studies, medial patellofemoral ligament reconstruction demonstrated consistent success in reducing redislocation rates to below 5% in appropriately selected patients. Mean postoperative Kujala scores ranged from 85 to 92, with similar improvements in Lysholm and Tegner scales. Isolated reconstruction was preferred in patients with mild anatomical abnormalities, while combined procedures (such as tibial tubercle osteotomy or trochleoplasty) were indicated in cases with elevated tibial tubercle–trochlear groove distance or high-grade trochlear dysplasia. Pediatric populations benefited from physeal-sparing techniques. Reported complication rates ranged from 2% to 7%. This review confirms the effectiveness of medial patellofemoral ligament reconstruction in managing recurrent patellar instability. Patient selection based on anatomical parameters and surgical precision are critical to successful outcomes. The procedure yields high functional recovery and return-to-sport rates with a low incidence of complications.