Quadriceps versus Hamstrings Tendon Graft for Medial Patellofemoral Ligament (MPFL) Reconstruction in Paediatric Patients

This is a prospective randomized controlled trial (RCT) comparing outcomes in paediatric patients undergoing medial patellofemoral ligament (MPFL) reconstruction with one of two graft constructs: 1) a graft constructed by the patient's own harvested hamstring tendon (HT), or 2) a graft constructed by the patient's own harvested quadriceps tendon (QT). The HT graft is harvested from the hamstring tendons at the back of the thigh and above the knee, while the QT graft is harvested from the quadriceps tendon at the front of the thigh and above the knee. Each graft is harvested at the beginning of the surgical procedure, and then subsequently used to reconstruct the new MPFL. The intervention (the surgical procedure with one of the two graft types) will be administered by the treating orthopaedic surgeon. While both constructs are generally used interchangeably, for the purpose of trial registration the 'intervention' is the QT graft. The surgical time for both techniques remains the same, and takes approximately 45 minutes in length. This 45-minute period includes both the graft harvest and the reconstructive procedure (i.e. the entire surgical procedure). The appropriate intervention will be ensured in all patients via internal monitoring by the research team, liaising with a specific member of the research team that is independent to the research study team and on-site for all surgeries). Following surgery, a standardized rehabilitation program will be followed by all patients, monitored by the patient's individual therapist. This rehabilitation program will generally require therapist visits every 1-2 weeks as required over the initial 12 weeks (as is the case through standard clinical practice), followed by periodic supervised therapy from 3-9 months post-surgery. Briefly and, standardized across all patients, early in-patient exercises will focus on regaining knee range of motion (ROM), patella mobility and pain/swelling reduction. From 2-3 weeks post-surgery, out-patient rehabilitation (including the exact exercises, together with recommended sets, repetitions and loads) will be dictated by individual patient physical conditioning and progression. An initial focus on exercises to restore movement and bilateral functional weight bearing strength will be prescribed. From 6-weeks post-surgery, a focus on single leg strength capacity will be undertaken, with a criterion-based return to jogging, as well as jumping and hopping exercises from 3 months post-surgery.