Optimizing medial patellofemoral ligament reconstruction: a randomized trial of 3D-printed guide plates for enhanced femoral tunnel accuracy and early functional recovery

This study aimed to determine whether patient-specific 3D-printed guide plates enhance femoral tunnel placement accuracy, reduce operative time, and promote faster functional and kinematic recovery in medial patellofemoral ligament (MPFL) reconstruction compared to conventional techniques. Prospective, randomized controlled trial. Single academic tertiary care hospital. Sixty patients diagnosed with recurrent patellar dislocation were enrolled and randomly assigned to either a 3D-printed guide plate group (n = 30) or a conventional fluoroscopy-guided group (n = 30). Patients in the intervention group underwent MPFL reconstruction assisted by customized 3D-printed guide plates for femoral tunnel placement. The control group received conventional fluoroscopy-assisted MPFL reconstruction. Both groups followed an identical rehabilitation protocol postoperatively. Primary outcomes included operative time, femoral tunnel placement accuracy (distance from the Schöttle point), knee function scores (Lysholm, Kujala, Tegner, IKDC), and 3D gait kinematics using the Opti-Knee system. Knee function scores were assessed preoperatively at 3, 6, and 12 months, and 3D gait kinematics were tested preoperatively at 3, 6, 9, and 12 months. The 3D-printed group had significantly shorter operative times (68 ± 12 min) than the conventional group (85 ± 16 min; p < 0.05). Femoral tunnel deviation was lower in the 3D group (5.42 ± 2.29 mm) compared to controls (7.65 ± 2.47 mm; p < 0.001). Functional scores were higher in the 3D group at 3 and 6 months (p < 0.05), and flexion-extension kinematics normalized by 6 months in the 3D group compared to 12 months in controls. 3D-printed guide plates improve femoral tunnel accuracy and reduce surgical time, accelerating early functional recovery. These findings support their clinical utility as a superior alternative to conventional guidance methods.