The Superficial "Swing-Down" Quadriceps Tendon Autograft is a Viable Option for Medial Patellofemoral Ligament Reconstruction: A Systematic Review.

Abstract Purpose The purpose of this systematic review is to ascertain the reported clinical outcomes and complication profiles of medial patellofemoral ligament (MPFL) reconstruction performed using a superficial “swing-down” quadriceps tendon autograft. Methods Three databases (PubMed, EMBASE, and MEDLINE) were searched from January 1, 2000 to April 06, 2020. Keywords used in the search included: "medial patellofemoral ligament" and "reconstruction". After screening based on inclusion and exclusion criteria, patient demographics, graft type, outcomes, and complications were extracted. Methodological Index for Non-Randomized Studies criteria were used to assess the quality of each included study. Results Eleven studies were included, comprising data from 226 patients with mean follow up ranging from of 12 - 38 months. All reconstructions utilized a superficial “swing-down” quadriceps tendon autograft fixed at 20-30 of knee flexion where reported. Eight of eleven studies reported significant improvement in patient reported outcomes such as Kujala score, Lysholm score and Tegner score. The mean preoperative Kujala score ranged from 35.8 to 82.1 (167 patients), while the mean postoperative Kujala score ranged from 88.4 to 94.8 (197 patients). The mean of the preoperative Lysholm score ranged from 43.3 to 79.3 (77 patients), while the mean of the postoperative Lysholm score ranged from 81.9 to 90.9 (99 patients). The I 2 statistic for Lysholm and Kujala scores were 94% and 97% respectively. Across data reported on 194 patients, there was no incidence of patellar redislocation, patellar fracture or graft site morbidity. Conclusion The quadriceps tendon produced improved clinical outcomes with low rates of recurrent postoperative patellar dislocation. These data suggest that the quadriceps tendon remains a suitable alternative for MPFL reconstruction and should remain part of the armamentarium of knee ligament surgeons. Level of Evidence Systematic Review of Level III-IV studies.