Journal of Pediatric Orthopaedics - 2026-09-01 - Journal Article; Systematic Review; Comparative Study
Autograft Versus Allograft in Pediatric Medial Patellofemoral Ligament Reconstruction: A Systematic Review.
Perez-Espina SM, Zirbes CF, Henriquez A, Amanah A, Luo EJ, Lau BC
Topics
Key Takeaway
In 849 pediatric knees undergoing MPFL reconstruction, recurrent dislocation rates were statistically equivalent between autograft (5.5%) and allograft (9.1%), though allograft patients returned to sport at or above preoperative level more frequently (90.9% vs. 71.2%, p=0.0002).
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Summary
This PRISMA-compliant systematic review compared autograft versus allograft MPFL reconstruction outcomes in pediatric patients across 23 studies. Autograft (640 knees) showed statistically significant improvements in Kujala, Lysholm, and VAS scores, while allograft (209 knees) did not reach significance on these measures. Recurrent dislocation rates were 5.5% autograft versus 9.1% allograft (p=0.07), and overall RTS rates were equivalent (90.9% vs. 92.9%), but allograft patients returned at or above preoperative sport level significantly more often (90.9% vs. 71.2%, p=0.0002).
Key Limitation
The allograft cohort is less than one-third the size of the autograft cohort and derived from heterogeneous retrospective studies, making the return-to-sport level comparison susceptible to selection bias and confounding by baseline activity level.
Original Abstract
BACKGROUND
Patellofemoral instability (PFI) is common in pediatric athletes, with up to 40% developing recurrent instability. Medial patellofemoral ligament (MPFL) reconstruction is commonly performed using either autograft or allograft tendon, but no comprehensive review has directly compared the outcomes between the 2 in pediatric patients. This systematic review evaluates patient-reported outcomes, return-to-sport (RTS) rates, and complications for autografts versus allografts.
METHODS
Following PRISMA guidelines, 2 independent reviewers conducted a systematic review of PubMed. Studies reporting MPFL reconstruction in pediatric patients were included. Extracted variables included study characteristics, patient demographics, outcomes, RTS, complications, and revision rates. Statistical testing and meta-analysis were conducted.
RESULTS
Twenty-three studies comprising 849 knees in 808 patients (57.8% female, average age 14.4±1.5 y; mean follow-up duration of 46.2±25.0 mo) were included. Autografts were utilized in 640 knees (619 patients) and allografts in 209 knees (189 patients). Kujala scores increased for both allograft and autograft patients, with significance in the autograft cohort ( P <0.0001). Autograft patients experienced significant improvements in Lysholm scores ( P =0.002) and VAS pain ( P =0.01). Rates of RTS were similar between allograft and autograft (92.9% vs. 90.9%). However, significantly more allograft patients returned to sport at a level equal to or higher than preoperatively (90.9% vs. 71.2%, P =0.0002). The rate of recurrent dislocation was 5.5% in autograft patients and 9.1% in allograft patients, with no significant difference ( P =0.07).
CONCLUSION
Patient-reported outcomes and recurrent dislocation rates appear comparable between allograft and autograft for pediatric patients undergoing MPFL reconstruction. Rates of return to sport were high in both cohorts, and limited data suggest that patients with allografts may return at equal or higher levels more frequently than autograft patients. Given sparse data, particularly on allograft patients, generalizability is limited. Further prospective studies are needed to investigate the relative risks and benefits of graft choice in this population.
LEVEL OF EVIDENCE
Level III-systematic review.