Does patella alta lead to worse clinical outcome in patients who undergo isolated medial patellofemoral ligament reconstruction? A systematic review

Introduction: The aim of this systematic review is to determine the effect of patella height on clinical outcomes after isolated MPFL reconstruction for patella instability. Our primary hypothesis is that patients with patella alta report similar outcomes after isolated MPFL reconstruction compared to patients with normal patella height. Methods: A review of the literature was performed according to the PRISMA guidelines. PubMed, EMBASE, and the Cochrane Library were searched from inception to January 10th 2018. Studies were identified using synonyms for “medial patellofemoral ligament”, “reconstruction” and “patella alta”. Results: The search resulted in 467 reports on PubMed, 175 on EMBASE and 3 on the Cochrane Library. We included and analyzed in detail six studies describing outcomes after isolated medial patellofemoral ligament reconstruction with regard to patellar height. We found that both patients with patella alta and normal patella height reported satisfactory outcomes after isolated medial patellofemoral ligament reconstruction. However, because of applied exclusion criteria in the included studies the total number of patients with severe patella alta was small (13/74 patients with patella alta, 18%). Conclusions: Based on the current literature we suggest that additional tibial tubercle distalisation is not mandatory in patients with mild patella alta (Caton–Deschamps Index 1.2–1.4). To assess the best indications for different surgical procedures for patients with patella instability future research is needed to develop a clear and uniform definition of relevant patella alta. Level of evidence: III.