Graft choice for child and adolescent medial patellofemoral ligament reconstruction: a systematic review

Background:

Medial patellofemoral ligament (MPFL) reconstruction is a common procedure for child and adolescent patellofemoral instability. Graft choice remains debated, with hamstring autograft being most frequent. This systematic review aimed to assess the safety and clinical effectiveness of isolated MPFL reconstruction in children and adolescents based on graft choice, to guide clinical decision-making.

Methods:

MEDLINE and EMBASE were searched from 1946 to June 21, 2023, for randomized controlled trials, cohort studies, case–control studies, and case series of patients ≤18 years old undergoing MPFL reconstruction. Risk of bias was assessed using the Cochrane tool for RCTs and Joanna Briggs Institute checklists for observational studies. Random-effects meta-analysis was planned where possible.

Results:

Twenty-six studies (19 case series, 6 cohort studies, and 1 case–control study) with 844 procedures were included. No RCTs were identified. Case series had a mean JBI critical appraisal score of 7.6/10, while cohort studies scored 8.5/11. Redislocation rates ranged from 4 to 10% across graft types (gracilis 7%, semitendinosus 10%, quadriceps 8%, augmented tape 6%, and mixed 9%). The median postoperative Kujala scores ranged from 88.6 to 92.2.

Discussion:

Short-term data suggest that isolated MPFL reconstruction has good outcomes regardless of graft choice. However, evidence was limited by lack of RCTs, short follow-up, and under-reporting of risk factors. Most studies provided Centre for Evidence-Based Medicine Level 3–4 (case series) evidence. Better comparative studies are needed with risk stratification to allow the comparison of techniques for this procedure. Levels of evidence: CEBM Levels 3–4.