Superficial Quadriceps Versus Hamstring Tendon Grafts for Medial Patellofemoral Ligament Reconstruction: A 2-Center Comparative Study

Background: Medial patellofemoral ligament (MPFL) reconstruction is an established treatment for recurrent patellar instability. Techniques requiring patellar drilling (tunnels or sockets for fixation) may increase the risk of iatrogenic patellar fracture. Purpose/Hypothesis: The purpose was to compare clinical outcomes and complications after MPFL reconstruction using a superficial quadriceps tendon (QT) graft versus a hamstring tendon (HT) graft) fixed with patellar all-suture anchors. It was hypothesized that the superficial QT technique would yield patient-reported outcomes comparable with the HT technique, with a different profile of patella-related complications. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective, 2-center review identified 47 patients (49 knees) who underwent MPFL reconstruction for recurrent patellar instability. A total of 23 knees were reconstructed with a patellar tunnel–free superficial QT graft and 26 with an HT graft fixed to the patella using suture anchors and to the femur at the Schöttle point. Patients with prior patellar surgery, periarticular fractures, or insufficient follow-up were excluded. Preoperative radiographic parameters and patient-reported outcomes (Kujala, Lysholm, Tegner, and visual analog scale VAS for pain) were recorded. The primary outcome was the Kujala score at final follow-up; secondary outcomes included other scores and complications (recurrent instability, patellar fracture, positive apprehension, and range-of-motion limitation). Results: Groups were comparable in demographics and radiographic measures at baseline. The mean follow-up duration was 59.8 months in the QT group and 50.7 months in the HT group. No significant between-group differences were observed in Kujala, Lysholm, Tegner, or VAS pain scores (all P > .05). Overall complication rates were similar (21.7% vs 15.4%). Complications included redislocation, positive apprehension, flexion limitation, and 1 patellar fracture in the HT group. Patients who developed postoperative complications had lower clinical scores, irrespective of graft type. Conclusion: Superficial quadriceps and HT autografts provide similarly favorable clinical outcomes and complication rates in MPFL reconstruction. No patellar fractures occurred in the QT group; however, fracture rates were not statistically different between groups and the study was underpowered for rare events. The QT technique avoids patellar drilling and may be considered in patients perceived to be at higher risk for patellar fracture.