Quadriceps Versus Hamstring Tendon Autografts for Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-Analysis.

BACKGROUND

Medial patellofemoral ligament (MPFL) reconstruction is the primary surgical treatment for recurrent patellofemoral instability. Hamstring tendon (HT) autografts have traditionally been used, while quadriceps tendon (QT) autografts have gained popularity as an alternative. The purpose of this study was to compare clinical, functional, stability, and objective strength outcomes following MPFL reconstruction using QT versus HT autografts.

METHODS

PubMed, Scopus, and Ovid MEDLINE were searched. Comparative studies directly evaluating QT and HT autografts for isolated MPFL reconstruction were included. Primary outcome was postoperative Kujala score. Secondary outcomes included Lysholm score, Tegner activity score, pain visual analog scale (VAS), recurrent dislocation, apprehension test, and objective strength measures when available. Meta-analyses were conducted using fixed- or random-effects models based on heterogeneity.

RESULTS

Four comparative studies involving 246 patients met inclusion criteria. Meta-analysis demonstrated no statistically significant differences between QT and HT autografts in postoperative Kujala score, Lysholm score, Tegner activity score, or pain VAS. No recurrent patellar dislocations were reported in either group, and the incidence of postoperative apprehension was low and similar. Objective strength outcomes were reported in one study, which showed higher limb symmetry indices for knee extension and flexion in the QT group, while hamstring-to-quadriceps ratios were similar between grafts.

CONCLUSION

QT autografts provide comparable patient-reported outcomes and stability to HT autografts for MPFL reconstruction. However, the absence of recurrent dislocations in these cohorts should be interpreted with caution due to the small total sample size and the retrospective nature of the included studies.

REGISTRATION: PROSPERO (CRD420261294759).