Does graft choice influence the outcome of MPFL reconstruction in patients with patellofemoral instability and increased TT-TG distance?

A systematic review of the literature was conducted to determine the effect of graft choice on patient outcomes in patients undergoing a medial patellofemoral ligament (MPFL) reconstruction with concomitant tibial tubercle transfer (TTT). Utilizing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and QUORUM (Quality of Reporting of Meta-Analyses) protocol, a systematic search identified and analyzed the published literature pertaining to MPFL reconstruction with TTT. The literature search yielded eight eligible studies with a total of 183 knees treated with a MPFL reconstruction with TTT procedure involving either a gracilis autograft, a semitendinosus autograft, or a medial retinaculum autograft. The eight studies varied on the outcome measures reported, but the outcome measures most consistently used and assessed in this systematic review included the complication rate, postoperative instability rate, Kujala score, Lysholm score, International Knee Documentation Committee functional evaluation form, and the Tegner activity scale. Our study found that patients undergoing MPFL reconstruction with TTT resulted in good overall patient outcomes. No statistical difference was found between the graft choices on any of the outcome measures. While MPFL reconstruction with TTT resulted in low to moderate complication rates and low postoperative patellofemoral instability rates, one potential explanation for the postoperative instability and knee stiffness observed may derive from graft choice. Future research may consider addressing the effect of graft choice on improperly tensioned grafts and overmedialized TTTs.