Influence of graft source and configuration on revision rate and patient-reported outcomes after MPFL reconstruction: a systematic review and meta-analysis

Abstract

IV.

CORR Insights®: Does the Utilization of Allograft Tissue in Medial Patellofemoral Ligament Reconstruction in Pediatric and Adolescent Patients Restore Patellar Stability?

“…Given the clinical equipoise of redislocation rates in adults noted in the study by Weinberger and colleagues [8], and the similar clinical success in children reported by the authors of the current study, it would seem ethical to perform such a study. However, given the substantial resources required to perform randomized controlled trials, it would seem appropriate in the interim to compile and analyze existing multicenter registry data (ideally, data that were prospectively collected), in order to garner sufficient statistical power to control for relevant confounding variables.…”

“…For the time being, the results from the study by Drs. Hohn and Pandya, taken together with the findings in adults by Weinberger and colleagues [8], suggest that allograft tissue remains a reasonable option for MPFL reconstruction in children and adolescents, particularly in those with connective tissue disease or generalized ligamentous laxity.…”

“…Although they observed greater improvement in Kujala scores among patients who received autograft reconstructions, they noted no difference in the frequency of recurrent patellofemoral instability between groups (5.7% for autograft, 6.7% for allograft) [8]. This was evident despite the inclusion of all allograft processing techniques (including irradiation) which, if anything, would bias those results in favor of using autograft as allograft irradiation can lead to structural compromise [2].…”

“…Recently, Weinberger and colleagues [8] performed a meta-analysis of observational studies comparing clinical outcomes in adult patients following MPFL reconstruction with autograft versus allograft. Although they observed greater improvement in Kujala scores among patients who received autograft reconstructions, they noted no difference in the frequency of recurrent patellofemoral instability between groups (5.7% for autograft, 6.7% for allograft) [8].…”

Medial Patellofemoral Ligament Reconstruction in Adolescents Affected by Patellar Instability

“…Although it has been used successfully in adults [30,31], it could be indicated for use in adolescents, because it works toward preserving the original MPFL anatomy [13,32]. The procedure consists of the attachment of a semitendinosus tendon autograft near the proximal medial collateral ligament attachment on the femur, as a proxy for the femoral MPFL insertion site [33].…”