Superficial quadriceps and hamstring autograft show similar results in MPFL reconstruction
Key takeaways:
- MPFL reconstruction with superficial quadriceps autograft yielded similar clinical outcomes to those with hamstring autograft.
- Both procedures are “safe and reproducible” for patients with patellar instability.
According to published results, both superficial quadriceps autograft and hamstring autograft are “safe and reproducible” procedures for patients with patellar instability who undergo medial patellofemoral ligament reconstruction.
Researchers compared clinical outcomes between 22 patients (mean age of 25 years) who underwent MPFL reconstruction with superficial quadriceps autograft and 21 patients (mean age of 21 years) who underwent MPFL reconstruction with hamstring autograft between 2012 and 2021. Mean follow-up was 46.9 months in the superficial quadriceps autograft group and 61 months in the hamstring autograft group, according to the study. Researchers noted no differences between the groups for age, gender, side of injury, Caton-Deschamps ratio and tibial tuberosity-trochlear groove distance.
Overall, no complications or recurrent dislocations were reported for either group. Researchers found similar functional scores between the groups. Mean postoperative Kujala scores were 94.9 in the superficial quadriceps autograft group and 94.2 in the hamstring autograft group, while mean postoperative Lysholm scores were 94.1 in the superficial quadriceps autograft group and 93.2 in the hamstring autograft group. Range of motion was 140° in the superficial quadriceps autograft group and 138° in the hamstring autograft group.
“According to the reconstruction of MPFL, graft choice is of fundamental importance,” the researchers wrote in the study. “The most important finding of this study was that both procedures, superficial quadriceps and hamstring autograft for MPFL reconstruction, are safe and reproducible procedures with good clinical and functional outcomes,” they concluded.
Perspective
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I read with interest this retrospective comparative study by Prakasit Sanguanjit, MD, and colleagues comparing their results of MPFL reconstruction performed using superficial quadriceps tendon in 21 patients vs. hamstring autograft in 22 patients, with a minimum follow-up of 2 years. There were no postoperative dislocations or complications reported in either group, and the authors found no statistically significant differences in postoperative Kujala or Lysholm scores. The authors describe the theoretical advantages of the quadriceps tendon technique as not requiring an implant or tunnel in the patella, therefore decreasing the risk of patella fracture. They also acknowledge the small sample size and retrospective nature of this study to be limitations. This study reinforces the commonly held belief that there is no one best way to perform MPFL reconstruction surgery and that excellent results can be obtained using a variety of different techniques and graft sources.
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