Medial Quadriceps Tendon-Femoral Ligament Reconstruction Offers Favorable Clinical Outcomes and Low Complication...

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.

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.

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.

MQTFLR in combination with MPFLR (MPFCR) is a viable option for surgical management of patellofemoral instability, with favorable clinical outcomes supporting its use.

Level IV, systematic review of Level III and IV studies.