Abstract

Aim
To compare quadriceps and gracilis tendon autografts for MPFL reconstruction and compare the clinical and biomechanical properties, and surgical risks associated with quadriceps and gracilis tendon autografts used in medial patellofemoral ligament reconstruction. It aims to identify which graft replicates the native MPFL function, greater post operative stability, and minimal complications.

Method
A systematic literature review was conducted with an emphasis on biomechanical properties, and surgical risk related to gracilis and quadriceps tendon grafts for MPFL reconstruction using PubMed, ScienceDirect, and Google Scholar. Keywords used were “MPFL reconstruction”, “quadriceps tendon” and “gracilis tendon”.

Results
Both the grafts demonstrated increased functional results postoperatively, with no significant difference in their mean Kujala and lysholm scores. The quadriceps tendon exhibited significant elongation enabling it to acquire similar properties to that of the MPFL ligament with the stiffness values closer to the ligament. But higher tensile strength was observed in the gracilis tendon, but the risks include tunnel widening and patellar fracture due to the patellar drilling. Use of the QT as the graft avoids the bone tunnels as the graft is secured to the medial soft tissue and the Schöttle’s point, reducing the fracture risk. GT harvest is associated with hamstring weakness, anterior knee pain and sensory impairments due to its proximity to the infrapatellar branch of the saphenous nerve.

Conclusions
Both grafts are viable for reconstruction. Quadriceps tendon provides anatomical similarity and reduced surgical risks while gracilis provides greater tensile strength. Due to these advantages, further research on QT graft is recommended.