Autograft vs Allograft Comparison in Pediatric Medial Patellofemoral Ligament Reconstruction

Abstract

Background: Patella instability and medial patellofemoral ligament (MPFL) injury are frequently encountered in pediatric patients. MPFL reconstruction is often chosen to treat this condition with good results; however, no consensus has been reached about which graft or technique to use. The purpose of this study was to evaluate the differences in graft survivorship, clinical outcomes (assessed with Kujala scores), and cost between autograft and allograft usage in MPFL reconstruction in pediatric patients. Methods: In this retrospective review of patients who underwent MPFL reconstruction between 2012-2015, autograft gracilis tendon was used for Group 1, and allograft gracilis tendon was used for Group 2. Outcomes were graft survivorship, postoperative Kujala scores, operative time, costs, graft size, and tibial tubercle-trochlear groove distance. Results: Fifty-six patients were included in this study, 21 in Group 1 and 35 in Group 2. No differences in age, sex, or chronicity were seen between the groups. Patients in Group 1 had longer operative times (134.5 minutes vs 97.3 minutes, P=0.0002), higher rates of graft failure (28.6% vs 0%, P=0.0037), and lower Kujala scores (80.3 vs 92.1, P=0.0032) compared to Group 2. All graft failures occurred in patients with chronic patella dislocations and occurred an average of 13.8 months postoperatively. Overall, autograft was costlier than allograft because of the cost of reoperation. Conclusion: This study supports the use of allograft for chronic patellar instability because of improved graft survivorship and clinical outcome scores, as well as the lower cost and reoperation rate.

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 ).…”

“…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).…”

“…Fisher exact test was used for comparison of failure rate between the autograft and allograft groups. A cost analysis was reported from a single included study 8 ; no separate cost analyses were performed.…”

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls

“…Weakening the already weaker medial structures by harvesting an adductor graft to use for reconstruction is not consistent with balancing the forces acting on the patellofemoral joint. Furthermore, in a recent retrospective review of gracilis autograft versus allograft in 56 pediatric patients from 2012 to 2015, Hendawi et al concluded that autograft had longer operating times and higher graft failure at an average of 13.8 months when compared with allograft [55]. Larger systematic reviews have shown comparable revision rates and postoperative functional outcome scores between autograft and allograft MPFL reconstruction in adult patients [15].…”

Dynamic–Anatomical Reconstruction of Medial Patellofemoral Ligament in Open Physis

“…Different techniques have been described that seek to reconstruct the ligament, which vary according to the graft choice, form and method of fixation, tension, and anatomic insertion site. [5][6][7][8] The latter is the point of most controversy, describing multiple locations at the level of the patella and the femur.…”