Comparable outcomes between quadriceps and hamstring tendon autografts for isolated medial patellofemoral ligament reconstruction: A systematic review of studies with minimum 2-year follow-up.

Abstract

To systematically review existing evidence to discern the most effective autograft between the hamstring tendon (HT) and the quadriceps tendon (QT) for isolated medial patellofemoral ligament (MPFL) reconstruction to address recurrent patellar instability. Medline, Embase and Scopus search strategies were developed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Only studies that included isolated MPFL reconstruction (MPFLR) using quadriceps or hamstring autograft on patients 12 years or older affected by recurrent patellofemoral instability with a minimum follow-up of 2 years were considered. The primary outcome of this review was the re-dislocation rate, and secondary outcomes included patient-reported outcome measures (PROMs), complications and radiographic parameters. Twelve studies, comprising 339 patients who underwent isolated MPFLR using HT autograft and 139 patients using QT autograft (follow-up range, 24-120 months), were included. Only one HT study reported patellar re-dislocations following MPFLR, with four patients requiring revision surgery. All other studies reported nil patellar re-dislocation. All studies showed significant mean improvements in postoperative Kujala (range of improvement in HT group from 26.5 to 41.4; QT group from 6.6 to 53.0) and Lysholm scores (range of improvement in HT group from 41.7 to 45.84; QT group from 10.9 to 46.0). Five studies provided postoperative Tegner Activity scores (postoperative range: 4.0-7.6). Four studies reported significant decreases in patellar tilt angle (PTA) postoperatively (range in HT group: 12.6-16.3; QT group: 13.0). Five studies reported significant decreases in the pain scale (visual analogue scale) postoperatively (range: 1.0-1.9). Seven studies reported that all patients had a full range of motion postoperatively. There is no significant difference in re-dislocation rate or PROMs between isolated MPFLR done with HT compared to QT autograft. Major limitations of this systematic review include a lack of strong outcome measures specific to patients with patellofemoral instability, along with few comparative studies. Level IV, a systematic review of Level I-IV studies.