FUNCTIONAL OUTCOME OF MEDIAL ATELLOFEMORAL LIGAMENT (MPFL) RECONSTRUCTION IN RECURRENT PATELLAR DISLOCATION: A COMPARATIVE STUDY OF GRACILIS AUTOGRAFT VS. LARS SYNTHETIC GRAFT

Abstract

Background: Recurrent patellar dislocation is a debilitating condition predominantly affecting young, active individuals, with an annual incidence estimated between 5.8 and 7.0 per 100,000 persons. The medial patellofemoral ligament (MPFL) is the primary passive restraint providing 50–60% of medial patellar stability and is torn in virtually all acute patellar dislocation episodes. Despite numerous reported surgical techniques, optimal graft selection for MPFL reconstruction (MPFLR) remains a subject of ongoing clinical debate. Objectives: To compare the functional outcomes, patellar stability, complication profiles, and return- to-sport rates  of  MPFL reconstruction  using  gracilis  tendon  autograft  versus  LARS  (Ligament Augmentation  and Reconstruction  System)  synthetic  ligament  in  patients  with  recurrent  patellar dislocation. Methods: A prospective randomized controlled trial enrolled 40 patients (mean age 24.8 years; 27 males) presenting with recurrent patellar dislocation (two or more episodes) between January 2024 and December 2025. Patients were randomised into Group A (gracilis autograft, n=20) and Group B (LARS synthetic graft, n=20). Primary outcomes were Kujala Patellofemoral Score, IKDC Subjective Knee Score, and Lysholm Knee Score at 24 months. Secondary outcomes included VAS pain, patellar apprehension test, time to return to sport, range of motion, and complication rates. Results: Both groups demonstrated significant functional improvement from baseline (p<0.001). At 24 months, mean Kujala scores were 86.4±5.2 (Group A) versus 83.1±6.0 (Group B) (p=0.04). IKDC scores were 82.7±6.1 versus 79.5±7.3 (p=0.07), and Lysholm scores 88.3±5.4 versus 84.7±6.2 (p=0.06). Donor-site morbidity was significantly higher in Group A (15.8% vs 0%, p=0.04). Recurrence rates were comparable (5.3% vs 5.0%, p=0.97). Return to sport was earlier in Group A (18.2±2.8 vs 20.1±3.3 weeks, p=0.05). Conclusion: Both gracilis autograft and LARS synthetic graft yield excellent and durable functional outcomes following MPFL reconstruction for recurrent patellar dislocation. Gracilis autograft provides marginally superior scores and earlier return to sport but carries a higher donor-site morbidity. LARS synthetic graft is a viable alternative, particularly in revision cases or when hamstring sacrifice is undesirable.