Autograft Versus Allograft in Pediatric Medial Patellofemoral Ligament Reconstruction: A Systematic Review

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.