Abstract
Purpose
To determine the rate of recurrent dislocation and patellar instability following medial patellofemoral ligament (MPFL) reconstruction with allograft or autograft tissue and compare patient-reported outcomes for patients undergoing allograft and autograft MPFL reconstruction.
Methods
One hundred and fifteen MPFL reconstructions (78 allograft, 37 autograft) without concurrent bony procedures performed between 2008 and 2014 by four sports medicine fellowship-trained orthopedic surgeons at our center were identified. Patient demographics and surgical data were identified by chart review. Chart review and patient interviews were undertaken to identify recurrent patellar dislocations and as recurrent subjective patellofemoral instability. Recurrent dislocation and subjective instability risk were compared between the allograft and autograft groups.
Results
Eighty-seven patients (76%) with complete baseline data and minimum 1-year follow-up were contacted at a mean of 4.1 years following isolated MPFL reconstruction, including 57 patient with allograft reconstructions and 30 with autograft reconstructions. No significant differences in patient sex, age at reconstruction, body mass index, or time to follow-up were noted between groups. Recurrent dislocation occurred in 2 patients in the allograft group (3.5%) and 1 patient in the autograft group (3.3%), (n.s.). Recurrent subjective instability occurred in 17 patients in the allograft group (28.9%) and 11 patients in the autograft group (36.7%), (n.s.). No significant differences in patient-reported outcomes were noted between groups.
Conclusion
The use of either allograft or autograft tissue for MPFL reconstruction results in low (< 3%) risk of recurrent patellar dislocation. Risk of recurrent subjective instability is higher but is similar for both graft types. Surgeons can utilize either graft choice at their discretion without anticipating a significant impact of graft choice on patient outcomes.
Level of evidence
III.
Similar content being viewed by others
References
Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med 28(4):472–479
Beasley LS, Vidal AF (2004) Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr 16(1):29–36
Boden BP, Pearsall AW, Garrett WE Jr, Feagin JA Jr (1997) Patellofemoral Instability: evaluation and management. J Am Acad Orthop Surg 5(1):47–57
Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Jt Surg Am 75(5):682–693
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26
Ellera Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8(3):335–340
Feller JA, Richmond AK, Wasiak J (2014) Medial patellofemoral ligament reconstruction as an isolated or combined procedure for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 22(10):2470–2476
Franz W, Baumann A (2016) Minimally invasive semitendinosus tendon harvesting from the popliteal fossa versus conventional hamstring tendon harvesting for ACL reconstruction: a prospective, randomised controlled trial in 100 patients. Knee 23(1):106–110
Frosch S, Balcarek P, Walde TA, Schuttrumpf JP, Wachowski MM, Ferleman KG, Sturmer KM, Frosch KH (2011) The treatment of patellar dislocation: a systematic review. Z Orthop Unfall 149(6):630–645
Greis PE, Koch BS, Adams B (2012) Tibialis anterior or posterior allograft anterior cruciate ligament reconstruction versus hamstring autograft reconstruction: an economic analysis in a hospital-based outpatient setting. Arthroscopy 28(11):1695–1701
Hagemeijer NC, Claessen F, de Haan R, Riedijk R, Eygendaal DE, van den Bekerom MP (2017) Graft site morbidity in Elbow ligament reconstruction procedures: a systematic review. Am J Sports Med 45(14):3382–3387
Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 349:174–182
Hettrich CM, Dunn WR, Reinke EK, Spindler KP (2013) The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort. Am J Sports Med 41(7):1534–1540
Kaeding CC, Aros B, Pedroza A, Pifel E, Amendola A, Andrish JT, Dunn WR, Marx RG, McCarty EC, Parker RD, Wright RW, Spindler KP (2011) Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a MOON prospective longitudinal cohort. Sports Health 3(1):73–81
Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, Spindler KP (2015) Risk Factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. Am J Sports Med 43(7):1583–1590
Maenpaa H, Lehto MU (1997) Patellofemoral osteoarthritis after patellar dislocation. Clin Orthop Relat Res 339:156–162
Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF (2001) Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med 29(2):213–218
Matic GT, Magnussen RA, Kolovich GP, Flanigan DC (2014) Return to activity after medial patellofemoral ligament repair or reconstruction. Arthroscopy 30(8):1018–1025
Mistry H, Metcalfe A, Colquitt J, Loveman E, Smith NA, Royle P, Waugh N (2019) Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective. Knee Surg Sports Traumatol Arthrosc 27(6):1782–1790
Mitchell J, Magnussen RA, Collins CL, Currie DW, Best TM, Comstock RD, Flanigan DC (2015) Epidemiology of patellofemoral instability injuries among high school athletes in the United States. Am J Sports Med 43(7):1676–1682
Oliva F, Ronga M, Longo UG, Testa V, Capasso G, Maffulli N (2009) The 3-in-1 procedure for recurrent dislocation of the patella in skeletally immature children and adolescents. Am J Sports Med 37(9):1814–1820
Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Jt Surg Am 90(3):463–470
Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96
Schneider DK, Grawe B, Magnussen RA, Ceasar A, Parikh SN, Wall EJ, Colosimo AJ, Kaeding CC, Myer GD (2016) Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations: a systematic review and meta-analysis. Am J Sports Med 44(11):2993–3005
Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40(8):1916–1923
Sharma A, Flanigan DC, Randall K, Magnussen RA (2016) Does gracilis preservation matter in anterior cruciate ligament reconstruction? A Syst Rev Arthrosc 32(6):1165–1173
Shea K, Nilsson K (2006) Patellar discloation in skeletally immature athletes. Oper Tech Sports Med 14(3):188–196
Sillanpaa P, Mattila VM, Iivonen T, Visuri T, Pihlajamaki H (2008) Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc 40(4):606–611
Sillanpaa PJ, Mattila VM, Visuri T, Maenpaa H, Pihlajamaki H (2011) Patellofemoral osteoarthritis in patients with operative treatment for patellar dislocation: a magnetic resonance-based analysis. Knee Surg Sports Traumatol Arthrosc 19(2):230–235
Smith TO, Chester R, Hunt N, Cross JL, Clark A, Donell ST (2016) The Norwich Patellar Instability Score: validity, internal consistency and responsiveness for people conservatively-managed following first-time patellar dislocation. Knee 23(2):256–260
Spindler KP, Murray MM, Devin C, Nanney LB, Davidson JM (2006) The central ACL defect as a model for failure of intra-articular healing. J Orthop Res 24(3):401–406
Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93–101
Stein B, Ahmad C (2007) The management of patellar instability in the skeletally immature patient. Oper Tech Orthop 17(4):250–256
Stupay KL, Swart E, Shubin Stein BE (2015) widespread implementation of medial patellofemoral ligament reconstruction for recurrent patellar instability maintains functional outcomes at midterm to long-term follow-up while decreasing complication rates: a systematic review. Arthroscopy 31(7):1372–1380
Tompkins MA, Arendt EA (2015) Patellar instability factors in isolated medial patellofemoral ligament reconstructions–what does the literature tell us? A systematic review. Am J Sports Med 43(9):2318–2327
Weinberger JM, Fabricant PD, Taylor SA, Mei JY, Jones KJ (2017) Influence of graft source and configuration on revision rate and patient-reported outcomes after MPFL reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 25(8):2511–2519
Woo R, Busch MT (1998) Management of patellar instability in children. Oper Tech Sports Med 6(4):247–258
Funding
The authors received no funding for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
David C. Flanigan is a consultant for Depuy Mitek, Inc., Smith & Nephew, vericel, Ceterix Orthopaedics, Conmed, Histogenics Corporation, Zimmer Inc.
Ethical approval
This study was approved by the Biomedical Institutional Review Board of The Ohio State University.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Flanigan, D.C., Shemory, S., Lundy, N. et al. Medial patellofemoral ligament reconstruction with allograft versus autograft tissue results in similar recurrent dislocation risk and patient-reported outcomes. Knee Surg Sports Traumatol Arthrosc 28, 2099–2104 (2020). https://doi.org/10.1007/s00167-020-05920-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-020-05920-x