Summary

Quadriceps tendon (QT) reconstruction for medial patellofemoral ligament (MPFL) in recurrent patella dislocation provides good functional outcomes, high patient satisfaction, and a low rate of complications, with no significant differences compared to hamstring tendon grafts.

Abstract

Introduction

The medial patellofemoral ligament (MPFL) has been identified as an important stabilizer of the patella and reconstruction can be done with soft tissue grafts such as hamstring (gracilis and semitendinosus) or quadriceps tendons (QT). The aim of this review is to assess the functional and clinical outcomes of QT for MPFL reconstruction in recurrent patella dislocation.

Methods

Three online databases, PUBMED, MEDLINE and EMBASE, were used and studies including functional and clinical outcomes were included. The inclusion criteria were clinical studies reporting on clinical and functional outcomes using quadriceps tendon for isolated MPFL reconstruction in recurrent patella dislocation. Statistical analysis was performed using Review Manager (RevMan) (Version 5.4, The Cochrane Collaboration, 2020). For dichotomous data, Risk Difference with 95% confidence intervals was calculated by inverse-variance weighting using a random-effects model framework.

Results

14 studies met the inclusion criteria. Twelve studies were non-comparative and two were comparative non-randomized studies. There were 348 patients (350 knees) of which 296 (84.6%) had MPFL reconstruction with QT. Mean age was 20.1 years (range: 8–58), with a mean follow-up period of 30.8 months (range: 12–68). Two studies compared the use of QT vs hamstring tendons. Both studies reported patients with QT reconstruction to have significantly better PROMs score, pain score and range of motion post operatively.
The most common PROMs used were Lysholm, Kujala and Tegner and all showing significant improvement postoperatively (88.7 ± 6.7, 90.0 ± 6.26 and 5.3 ± 1.95 respectively). Mean satisfaction rate was 93.2% (range 85-100%). Mean post-operative range of motion was 0o-150o (range 0o - 170o) and all patients reported ability to squat upto 90o. Meta-analysis of the comparative studies showed no statistical significance between QT vs hamstring in post-operative Kujala [pooled mean difference -0.11, 95% Cl (-2.84 -2.61) p=0.93] and Lysholm scores [pooled mean difference 1.83, 95% Cl (-1.23 -4.88) p =0.24].
Overall complication rate was 2.8% (1 to 3%) and most common complication was hypertrophic scar (0.8%). Apprehension was reported in two patients (0.6%) and only one patient (0.3%) had recurrent instability that required reoperation in QT MPFLR. Revision rate was 2% (0 to 3%) and most common reason was superficial site infection (0.6%). In the comparative studies, no significant difference in complications was observed between the hamstring and QT groups. One of the comparative studies reported more patients in the hamstring group (59.4%, n=19) had sensory loss compared to the QT group (3.1%, n=1) on final followup, although the pooled analysis of sensory loss between QT and hamstring tendon grafts did not reach statistical significance, the trend favoured the QT grafts, which demonstrated lower rates of postoperative sensory loss [pooled risk difference -0.28, 95% Cl (-0.83 – 0.28) p = 0.33].

Conclusion

Quadriceps tendon for MPFL reconstruction offers good knee function and patient satisfaction with low rate of complications and recurrence.