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

Abstract

Background: Patients with recurrent lateral patellar dislocations are often treated with reconstruction of the medial patellofemoral ligament (MPFL). Purpose: To perform a systematic review to evaluate clinical outcomes and the risk of recurrent patellar dislocation after MPFL reconstruction (MPFLR) with autograft versus allograft. Study Design: Systematic review; Level of evidence, 4. Methods: The authors conducted a search of PubMed, the Cochrane Library, and Embase to identify studies comparing outcomes of MPFLR with autograft versus allograft. The inclusion criteria were full-text studies that directly compared clinical outcomes and/or risk of recurrent patellar instability between patients undergoing MPFLR with autograft versus allograft. A quality assessment was performed using the modified Coleman Methodology Score, and risk-of-bias assessment was performed using the Risk Of Bias In Non-randomized Studies–of Interventions and the Cochrane Collaboration tools. Results: Seven studies (1 evidence level 2, 3 level 3, 3 level 4) that met inclusion criteria were identified and included a total of 150 patients who underwent MPFLR with autograft and 193 with MPFLR with allograft. One study found a significantly higher failure rate among patients with autograft, and another study found a trend toward a significantly higher failure rate among patients with autograft. One study demonstrated no significant difference between postoperative tibial tubercle–trochlear groove distance (measured on magnetic resonance imaging scans) in failed versus successful grafts. One study found that patellar tilt angle improved significantly from preoperatively to postoperatively ( P < .001) but there was no difference between the groups. Kujala scores significantly improved for both autograft and allograft groups across studies. Two studies found significant differences in postoperative Kujala scores between the 2 groups, 1 of which found better scores in the allograft group ( P = .0032) and another in which scores were better in the autograft group ( P = .02). Conclusion: Patients undergoing MPFLR with either autograft or allograft can expect to experience improvement in clinical outcomes. Subjective outcomes improved to a similar degree in both groups. Graft failure was more frequently observed in patients with autograft. Allograft may be a better option for MPFLR owing to lower failure rate.

Medial Patellofemoral Ligament Augmentation Repair for Primary Patellar Dislocation With Concomitant Chondral or Osteochondral Injury in Children and Adolescents: Outcomes at Minimum 2-Year Follow-up

“…Although autografts are an option for MPFL reconstruction, the literature has demonstrated a slightly increased failure rate with an autograft when compared with an allograft. 1 Using synthetic, readily available suture tape is advantageous to negate tendon reaction and graft laxity. While suture tape can still lead to over- or undertightening, placing a hemostat under the tape while tightening can help prevent this.…”

Medial Patellofemoral Ligament Reconstruction Using the Medial Third of the Patellar Tendon: Camanho’s Technique

“… 20 reported no recurrent dislocation and no other complications in their study. In the literature, Aliberti et al., 18 in a systematic review including 150 patients who underwent MPFL reconstruction with autografts, reported a failure rate of 8.7%.…”

Midterm Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome

“…In a systematic review, the range of failure rate of autografts (0%-28.6%) was worse than that of allografts (0%-8.3%). 2 The authors concluded that allografts should be favored over autografts because of lower failure rate, shorter operative time, and decreased donor-site morbidity. In EDS, tendon elongation is much greater, and tendon stiffness is much lower than in controls.…”

“…If an autograft is chosen for MPFLR, then consideration should be given to use the larger semitendinosus tendon instead of the smaller gracilis tendon as significant higher failure rate was noted for gracilis autograft in the current study. 2 …”