Graft and fixation variations in medial patellofemoral ligament reconstruction: A prospective comparative analysis

To prospectively compare clinical and functional outcomes of three commonly used medial patellofemoral ligament (MPFL) reconstruction techniques: hamstring autograft with patellar suture anchor fixation, hamstring autograft with implant-less patellar fixation, and quadriceps tendon autograft.

In this prospective comparative study, 30 patients with recurrent patellar instability underwent MPFL reconstruction and were equally allocated into three groups: Group 1, semitendinosus or gracilis autograft with patellar suture anchor fixation and femoral interference screw fixation; Group 2, semitendinosus or gracilis autograft with implant-less patellar fixation and femoral screw fixation; and Group 3, quadriceps tendon autograft with femoral screw fixation. Femoral tunnel placement was anatomically guided at Schöttle's point. Functional outcomes were assessed preoperatively and at 3, 6, and 12 months using Kujala, Lysholm, and Tegner scores. Patient satisfaction and return-to-sports time were evaluated as secondary outcomes.

All three groups demonstrated significant improvement in Kujala, Lysholm, and Tegner scores over time (p < 0.001). However, no statistically significant differences were observed between the groups at any follow-up point. Secondary outcomes, including patient satisfaction and time to return to sports, were also comparable across groups at 12 months.

This study shows that All three MPFL reconstruction techniques provide comparable clinical outcomes. All groups demonstrated significant functional improvement at 12 months, with no differences in functional scores, patient satisfaction, or return-to-sport timelines. These findings suggest that, when anatomical principles are respected, surgeons may choose the technique best suited to patient factors and surgical expertise without compromising outcomes.