Allograft Reconstruction of Medial Patellar Stabilizers for Patellofemoral Instability: A Narrative Review

Patellofemoral instability is common and disabling, predominantly affecting young and physically active individuals. Reconstruction of the medial soft tissue restraints of the patella has become the cornerstone of surgical management for recurrent patellar dislocation. Allografts offer several advantages over autografts in this setting, including avoidance of donor-site morbidity, shorter operative time, and the flexibility to select graft dimensions without the constraints imposed by patient anatomy. These attributes are particularly relevant when reconstructing the medial patellofemoral ligament (MPFL), the medial quadriceps tendon-femoral ligament (MQTFL), and the medial patellotibial ligament (MPTL), whether in isolation or in combination. This narrative review examines the current evidence on allograft reconstruction of each of these structures in adults and in skeletally immature patients, addressing clinical outcomes, patient-reported outcome measures, complication rates, graft selection principles, surgical technique considerations, and the specific challenges posed by pediatric anatomy. The available literature supports allograft reconstruction of the medial patellar stabilizers as safe and effective. Patient-reported outcome measures are broadly comparable to those achieved with autografts, and re-dislocation rates are similar or modestly lower in several allograft series. In skeletally immature patients, allografts facilitate physeal-sparing and hardware-free fixation strategies that minimize the risk of iatrogenic growth disturbance. Combined MPFL and MQTFL reconstruction using allografts is an emerging and promising technique for both primary and revision settings. Further prospective comparative investigation with longer follow-up is required before definitive recommendations can be made.