Autograft vs Allograft Comparison in MPFL Reconstruction in Pediatric Patients

Abstract

Evaluate the differences in survivorship, clinical outcomes, and cost between autograft and allograft usage in Medial Patellofemoral ligament reconstruction in Pediatric patients This is a retrospective review of 56 patients who underwent MPFL reconstruction between 2012 and 2015 by a single surgeon for both acute and chronic patellar instability. Autograft Gracilis tendon was used for Group 1 ( 21 patients). Allograft Gracilis tendon was used for Group 2 (35 patients). Kujala Scores were gathered on all patients postoperatively. Survivorship, surgical time, and cost were calculated and compared. 56 patients were included in this study. There was no difference in age or chronicity between the groups. Group 1 (Autograft) showed significantly longer operative times (135 min vs 97 min; P < .001 ), higher rates of graft failure ( 28% vs 0%; P = .002) and worse Kujala Scores (80 vs 92 P = .003) postoperatively. All failures were in chronic dislocators and occurred at 14 months on average. With regards to cost, autograft did require more time for harvest and closure (40 min = $445 for this procedure) but allograft cost $1058. Overall, autograft was significantly more costly due to cost of reoperation. In our review of graft choices for MPFL reconstruction, allograft is recommended for chronic patellar instability due to improved survivorship and clinical outcome scores, lower overall cost, and reoperation rate.