Adolescent Medial Patellofemoral Ligament Reconstruction: A Comparison of the Use of Autograft Versus Allograft Hamstring

Abstract

Background:Recurrent patellar instability is commonly treated with medial patellofemoral ligament reconstruction (MPFLR), and the use of allograft in anterior cruciate ligament reconstructions has demonstrated inferior outcomes.Purpose:To compare the outcomes of allografts versus autografts in adolescent MPFLR for patellar instability.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective chart review was completed on patients younger than 18 years who underwent MPFLR for recurrent instability after failed nonoperative management over an 8-year period with a minimum 2-year follow-up. Patients were divided into autograft or allograft hamstring cohorts for comparison. Primary outcome measures were return to normal activity, incidence of redislocation/subluxation, pain, stiffness, other complications, and Kujala scores. Statistical analysis using unpaired t tests was performed, with an alpha value set at P < .05.Results:After criteria were applied, 59 adolescents (36 allograft, 23 autograft; 38 girls, 21 boys) with a mean ± SD age of 15.2 ± 1.7 years and a mean follow-up of 4.1 ± 1.9 years (allograft, 3.3 ± 1.1 years; autograft, 5.7 ± 2.1 years; P ≤ .001) were included. Seven patients had concurrent osteotomies (3 allograft, 4 autograft), 11 patients had concurrent loose body removals (5 allograft, 6 autograft), and 9 patients had concurrent lateral release (7 allograft, 2 autograft). Between groups, no significant difference was found in change between preoperative and most recent follow-up (mean, 1.2 ± 2.1) or rate of return to sports (mean, 73.3%). In total, 9 surgeries failed (3 allograft, 6 autograft). For the surviving grafts, a statistical difference in mean Kujala scores at final follow-up was noted (allograft, 92.7; autograft, 97.4; P = .02).Conclusion:We identified no significant differences in return to activity, pain score changes, and incidences of failure between patients undergoing MPFLR with allograft versus autograft. Although teenagers with surviving autograft MPFLR reported statistically higher Kujala scores, the mean score difference of 5 points was not clinically significant. It appears that using allograft tendon instead of autograft tissue for MPFLR in this teenage population does not adversely affect long-term outcomes.

Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability

“…Several recent surgical algorithms have been developed which generally focus on the patient’s skeletal maturity, TT–TG, trochlear dysplasia, coronal and rotational malalignment, and the presence of chondral lesions [ 78 , 79 , 80 , 81 ]. Medial patellofemoral ligament reconstruction has become the preferred method to address PFI and has demonstrated excellent results [ 82 , 83 , 84 , 85 , 86 , 87 , 88 ]. However, when coronal or transverse plane malalignment is present, consideration for correction of malalignment should be considered prior to MPFL reconstruction.…”

Autograft Versus Allograft for Medial Patellofemoral Ligament Reconstruction: A Systematic Review

“…Seven studies 4 , 7 , 8 , 14 , 16 , 23 , 24 met all criteria and were included in this systematic review ( Figure 1 ). The studies included 150 patients who underwent MPFLR with autograft and 193 with allograft ( Table 1 ).…”

“…Two studies 4 , 16 randomized patients to receive autograft or allograft. Kumar et al 14 allowed patients and their families to make a choice between autograft or allograft after discussion of risks and benefits. Four studies 7 , 8 , 23 , 24 did not describe how patients were allocated to receive autograft or allograft.…”

“…Scores ranging from 85 to 100 are excellent, 70 to 84 are good, 55 to 69 are fair, and <55 are poor. Risk of bias for the 6 nonrandomized 4 , 7 , 8 , 14 , 23 , 24 studies was assessed according to the Risk Of Bias In Non-randomized Studies–of Interventions (ROBINS-I 25 ) tool, which incorporates an assessment of bias due to confounding, selection of participants, deviations from intended interventions, completeness of outcome data, selection of outcomes reported, and other sources of bias. For the remaining randomized study, 16 risk of bias was assessed according to the Cochrane Collaboration risk-of-bias tool (Version 2).…”

The Bridge-Enhanced ACL Repair: A Review

“…Autografts can be harvested from the patient during the same operation (hamstring tendon, patellar tendon, or quadriceps tendon) or cadaveric allografts; although autografts are more commonly used, there lacks a clear consensus as to which is superior. [7][8][9][10][11] ACL reconstructions are generally considered successful (75-97% patient satisfaction), necessary, and low-risk procedures. [12][13][14][15][16] However, adverse consequences of the procedure can manifest beyond an immediate "successful" reconstruction.…”