Pedicled Strip of Quadriceps Tendon Graft for Primary Medial Patellofemoral Ligament Reconstruction in Recurrent Patellofemoral Instability: A Systematic Review
Bibliographic record
Abstract
PURPOSE: A systematic review of the literature was conducted to ascertain advantages and limitations, update current evidences, and investigate the role of a pedicled quadriceps tendon autograft for primary medio-patellofemoral ligament (MPFL) reconstruction in patients with recurrent patellofemoral instability. METHODS: The present systematic review was performed according to the PRISMA guidelines. The literature search was conducted in September 2020. All the clinical studies investigating the role of a pedicled strip of quadriceps tendon autograft for primary MPFL reconstruction in patients with recurrent patellofemoral instability were considered for inclusion. Studies investigating the role of MPFL reconstruction combined with additional surgical procedures except for lateral retinacular release were excluded. The methodological quality assessment was performed through the modified Coleman Methodology score. RESULTS: Data from 9 articles (191 procedures) were retrieved. The mean follow-up was 12 to 38 months. The mean age of the patients was 11.5 to 25.2 years. One hundred twenty of 191 patients were female. All clinical scores showed significant improvement following the procedures. The Kujala score improved of 32.52% points (P < 0.0001), the Lysholm score of 23.74% (P = 0.006), the Tegner scale improved of 8.6% (P = 0.02). Concerning complications, after surgery the apprehension test was positive in 5 of 166 patients, and persistent joint instability was found in 5 of 149 patients. No patient experienced any re-dislocations or underwent reoperations. CONCLUSIONS: The use of pedicled strip of quadriceps tendon as graft for MPFL reconstruction is a suitable choice in patients with recurrent patellar instability. Although frequently associated with a lateral release, it is unclear whether the latter is necessary for the success of the technique. Appropriately powered randomized controlled trials comparing this graft source to the others commonly used are necessary to at least ascertain the noninferiority of this graft to the others. LEVEL OF EVIDENCE: IV, Systematic review of Level III-IV studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.008 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".