Clinical Comparison Study Of Medial Patellofemoral Ligament Reconstruction In The Treatment Of Patellar Dislocation With Autografts Versus Allografts

Objective:To compare the clinical efficacy of autologous and allogeneic tendon reconstru-ction of the medial patellofemoral ligament in the treatment of patellar dislocation.This provides a theoretical basis for the selection of better femoral tunnel registration sites.Methods:A retrospective analysis of 53 patients who underwent patellofemoral ligament reconstruction surgery in the department of orthopedics of the first affiliated hospital of Nanchang University and Jiujiang hospital affiliated to Nanchang University from June 2015 to February 2019 was conducted.The grafts were divided into the autologous tendon group(group A)and the allogeneic tendon group(group B).In the autograft tendon group,autograft hamstring tendon was used to reconstruct the medial patellofemoral ligament,and in the allograft tendon group,allograft tendon was used to reconstruct the medial patellofemoral ligament.After the operation,the two groups of patients followed the same rehabilitation plan for rehabilitation exercise.They were followed up for 1 to 3 years.To compare the clinical treatment effect and complications of the two groups,knee function scores(Lysholm scores and Kujala scores)were recorded,and patella stability(patella extrapolation test and patella extrapolation fear test)was examined by manipulation,besides,X-ray,CT,and MRI were regularly reviewed to measure lateral shif and patellar tilt angle.Results:Among the 53 patients,25 were in the autologous tendon group(group A)and28 were in the allogeneic tendon group(group B).There was no significant difference between the two groups in gender(p=0.323),age(p=0.945),affected side(p=0.884),follow-up time(p=0.657),combined injury and other preoperative general data.There was no reoccurrence of dislocation after surgery in both groups,both the patella extrapolation test and the extrapolation fear test was positive before surgery andnegative after surgery.Lateral shif and patella inclination angle decreased from48.72±7.63?21.08±4.20 in group A and 49.59±7.38?20.74±3.06 in group B before surgery to10.82±2.64?9.61±1.93 in group A and11.21±2.71?9.92±1.80 in group B at the last postoperative follow-up.Lysholm scores and Kujala scores increased from57.88±7.62 ??58.92±8.17 points in group A,57.25±8.25?58.36±8.84 in group B before surgery,to 90.52±4.03?89.84±4.88 in group A,91.07±3.05?90.29±3.93 in group B at the last postoperative follow-up.The results were significantly improved compared with those before surgery.At the last postoperative follow-up,there were no significant differences between the two groups in lateral shif(p=0.602),patellar inclination angle(p=0.543),Lysholm scores(p=0.575)and Kujala scores(p=0.715).The operation time(p=0.001),incision length(p=0.00)and saphenous nerve injury(p=0.008)were shorter in the allogeneic tendon group,while the hospitalization expenses(p=0.001)were lower in the autogenous tendon group,and the differences were statistically significant.Conclusion:The reconstruction of the medial patellofemoral ligament by autologous tendon and allogeneic tendon can obtain satisfactory clinical efficacy,and there is no significant difference in postoperative clinical efficacy between the two.However,allograft tendons are superior to autologous tendons in terms of donor site trauma and operative time but require higher hospitalization costs.