Medial Patellofemoral Ligament Reconstruction Using Autograft vs Allograft in Pediatric Patients: A Systematic Review...

Medial patellofemoral ligament reconstruction (MPFLR) is the most common treatment option for pediatric patients with recurrent patellar instability. However, there is a lack of consensus regarding the superiority of allograft or autograft MPFLR for young patients. This systematic review aims to evaluate the clinical outcomes of allograft and autograft MPFLR in the pediatric and adolescent population.

Studies comparing allograft and autograft MPFLR in pediatric patients were identified from PubMed, Embase, and the Cochrane Library. Inclusion criteria included studies: 1) evaluating pediatric patients (≤21 years of age), 2) comparing clinical outcomes between MPFLR allograft and autograft, 3) published after January 1, 2000, and 4) published in English. Exclusion criteria included 1) meta-analysis, chapters, conferences, abstracts, case reports, editorials, or reviews, 2) studies performed in animal models, and 3) studies lacking direct comparisons between allograft and autograft. Nonrandomized studies were assessed for quality using the methodological index for nonrandomized studies, while randomized studies were assessed using the Cochrane risk-of-bias tool. A meta-analysis using the random-effects generalized linear mixed model was applied to compare the failure rates between the allograft and autograft treatment groups.

Four studies met the final inclusion criteria (2 level 3 retrospective comparative studies, 1 level 4 case series, and 1 level 2 multicenter randomized controlled trial). The aggregate data from all 4 studies displayed a higher rate of failure and higher odds of failure in the autograft group (P = .004). Postoperative Kujala scores were high for both autograft and allograft groups. While 1 study found greater Kujala scores in the allograft treatment group, another study reported greater scores in the autograft treatment group. The remaining 2 studies did not find significant differences in the Kujala scores between groups.

Among pediatric patients undergoing MPFLR, the use of autograft may be associated with higher failure rates compared to the use of allograft. Patient-reported outcomes improved with both autograft and allograft MPFLR, with no clear difference between the groups. Future studies should evaluate why autograft MPFLR may be associated with a higher risk of recurrent instability.

(1)While graft choice for medial patellofemoral ligament reconstruction (MPFLR) in the general population has been studied in the past, there is a gap in research for pediatric MPFLR, which this study aims to address.(2)This review found that outcomes were generally positive for MPFLR, whether allograft or autograft was used. However, autograft MPFLR had a higher rate of graft failure.(3)Given the synthesized evidence and the lack of donor site morbidity associated with the use of allograft, we recommend that pediatric sports surgeons consider using allograft when performing MPFLR.

IV, Systematic Review.