# Combined medial patellofemoral ligament and medial quadriceps tendon-femoral ligament reconstruction for patellar instability: a systematic review

## TL;DR

This systematic review evaluates the effectiveness of combining two ligament reconstructions to treat patellar instability, finding it to be safe and effective with low complication rates.

## Contribution

The study provides a systematic review of combined MPFL and MQTFL reconstruction outcomes for patellar instability, highlighting safety and effectiveness.

## Key findings

- Combined MPFL and MQTFL reconstruction showed low rates of recurrent dislocation and complications.
- Allografts were most commonly used, and soft tissue suture fixation was more frequent than tunnel fixation.
- The procedure was effective in both pediatric and adult patients with patellar instability.

## Abstract

Data on the clinical outcomes of combined medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL) reconstruction for patellar instability remain scarce.

A systematic literature search was conducted in Web of Science, Embase, and PubMed on June 9, 2025. All studies reporting clinical outcomes after combined MPFL/MQTFL reconstruction for patellar instability were included. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). General characteristics, surgical technique, clinical outcomes, satisfaction, and complications were recorded.

Five studies comprising 180 patients (188 knees) were included. The mean age was 14.8 years (range 12–22 years), and the mean follow-up was 34.6 months (range 24–49 months). Children and adolescents accounted for 67.8% of the cohort (n = 122). The mean Insall-Salvati ratio (ISR) or Caton-Deschamps index (CDI) was 1.2, and the mean tibial tubercle-trochlear groove (TT-TG) distance was 16.6 mm. Trochlear dysplasia was present in 86.2% of knees (162/180). Allografts were the most commonly used grafts (n = 103, 54.8%). Methods of quadriceps tendon fixation included soft tissue tunnel fixation (n = 61, 37.2%), and soft tissue suture fixation (n = 103, 62.8%). The overall complication rate was 8.0% (15/188), with recurrent dislocation occurring in 2.1%. No patellar fractures or growth distrubances were reported.

Combined MPFL and MQTFL reconstruction is a safe and effective technique for treating patellar instability in both pediatric and adult patients, demonstrating low rates of recurrent dislocation and complications. However, the optimal surgical technique remains controversial.