# Comparable clinical and functional outcomes between biological and synthetic grafts for medial patellofemoral ligament reconstruction: A systematic review and meta‐analysis

## TL;DR

This study finds that synthetic and biological grafts have similar outcomes for medial patellofemoral ligament reconstruction, supporting synthetic grafts as a viable option.

## Contribution

This is the first systematic review and meta-analysis comparing long-term outcomes of synthetic versus biological grafts for MPFL reconstruction.

## Key findings

- No significant differences in functional scores (Kujala, Lysholm, Tegner) between synthetic and biological grafts.
- Similar complication and redislocation rates between the two graft types.
- Synthetic grafts are shown to be a viable alternative to biological grafts in MPFL reconstruction.

## Abstract

The medial patellofemoral ligament (MPFL) is an essential static stabiliser of the patella. In patients with patellofemoral dislocations and MPFL damage, surgical intervention is often necessary to restore stability. This typically involves reconstruction using either an autograft, allograft or synthetic graft. This study aimed to evaluate long‐term outcomes of biological grafts (autografts and allografts) versus synthetic grafts, by analysing parameters such as stability and complication rates.

A systematic search on Ovid, Medline, Embase, PubMed and Cochrane electronic databases was performed. Studies were included if they enroled adult patients (≥18 years) who had undergone isolated MPFL reconstruction for chronic patellofemoral instability, with a minimum follow‐up of 12 months. Data were pooled through meta‐analysis using an inverse‐variance and mixed‐effects model in RStudio to generate standardised mean differences or rate ratios with 95% confidence intervals.

Thirty‐two studies were included in this study, with 1508 patients. 224 were treated with synthetic grafts and 1284 with biological grafts. No statistically significant differences were observed between synthetic and biological grafts across all primary and secondary outcomes: Kujala score (Q = 1.24, p = 0.27), Lysholm score (Q = 1.62, p = 0.20), Tegner score (Q = 0.11, p = 0.74), postoperative complication rate (χ² = 0.0.1, p = 0.94), nor redislocation rates (χ² = 0.34, p = 0.56). These findings indicate comparable functional outcomes and safety profiles for biological versus synthetic grafts.

The findings of this study have shown clinical and functional outcomes to be similar when comparing synthetic and biologic grafts for MPFL reconstruction. These findings support the use of synthetic grafts as a viable alternative in the surgical treatment of chronic patella instability and emphasise the need for a meticulous and informed approach to graft selection for MPFL surgery.

Level IV.