Comparing Suture Anchor and Transosseous Methods for Patellar Fixation in Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-analysis.

Background: Two commonly used techniques for securing the tendon graft to the patella in medial patellofemoral ligament (MPFL) reconstruction include the suture anchor (SA) method and the transosseous (TO) method. This study aimed to compare the outcomes in groups of patients who underwent SA and TO methods for patellar fixation in MPFL reconstruction. Methods: A systematic review was carried out. The evaluation of methodological quality for the included studies utilized the Modified Coleman Methodology Score and Methodology Index for Non-Randomized Studies criteria.Meta-analysis was performed using odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Results: Four articles were included in this analysis, encompassing a total of 259 knees. Two studies were categorized as the level of evidence II, and two studies were categorized as the level of evidence III. Postoperative clinical outcomes, including Kujala, Lysholm, and International Knee Documentation Committee scores, did not statistically significantly differ between the SA and TO methods. Radiographic outcomes showed no statistically significant difference in congruence angle and patellar tilt angle between the two approaches at the minimal 2-year follow-up. Furthermore, the incidence of complications, specifically redislocation and patella fracture, was generally low, with no differences observed between the SA and TO methods. Conclusions: Both the SA and TO methods for patellar fixation in MPFL reconstruction contribute to improved clinical outcomes, displaying low complication rates. No statistically significant differences were observed in clinical and radiographic outcomes, as well as complications, between these two techniques. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-025-01453-y.