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. 2021 Oct 14;1(5):26350254211040821.
doi: 10.1177/26350254211040821. eCollection 2021 Sep-Oct.

Medial Patellofemoral Ligament Reconstruction

Margaret L Wright  1 , Ryan W Paul  1 , Kevin B Freedman  1   2
Affiliations

Medial Patellofemoral Ligament Reconstruction

Margaret L Wright et al. Video J Sports Med. .

Abstract

Background: Patellar instability is a relatively common condition in the young, active population and causes disruption of the medial patellofemoral ligament (MPFL). MPFL reconstruction is often performed to restore this medial stabilizer and reduce the risk of recurrent instability.

Indications: Isolated MPFL reconstruction has been shown to reduce the risk of recurrent patellar dislocation. It is indicated in our patients who have had more than 1 dislocation in the absence of other significant bony malalignment or cartilage defects that require concurrent surgery.

Technique description: Diagnostic arthroscopy is first performed to evaluate the patellar and trochlear cartilage surfaces. A medial approach to the patella is then performed and the 2 free limbs of the allograft are secured to the patella at the 9 to 11 (or 1 to 3) o'clock position. A small approach to the femoral insertion site of the MPFL is performed and confirmed with fluoroscopy, and the graft is secured to the femur with a biotenodesis screw. Postoperative examination confirms improved stability of the patella, and the patient performs a gradual return to play protocol.

Results: Recent studies have demonstrated overall good clinical outcomes after MPFL reconstruction, with improved patellar stability and high patient satisfaction. One systematic review found an 85% rate of return to sport with a low risk (7%) of recurrent subluxation or dislocation.

Discussion/conclusion: MPFL reconstruction is a reliable option for improving patellar stability in patients with recurrent dislocations. We believe our technique, which optimizes the fixation and footprint of the graft on the patella and allows for easy visualization of femoral anatomy on fluoroscopy, can improve the reproducibility of the procedure and provide optimal clinical outcomes.

Keywords: MPFL reconstruction; allograft; medial patellofemoral ligament; operative technique; patellar dislocation; patellar instability.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: K.B.F. is a paid consultant for DePuy and Vericel; is an educator for Liberty Surgical; and is a board or committee member for AOSSM. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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References

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