MPFL Reconstruction: Principles and Complications

Abstract

Medial patellofemoral ligament (MPFL) reconstructions have good results with few complications notwithstanding varied techniques used. Biomechanical and technical principles should be adhered to in preventing complications. The reconstructed MPFL should be tight in extension and lax in flexion. In cases of severe patella alta, a distalization of the tibial tubercle should be considered. With maximum quadriceps contraction the tension in the patellar tendon should be more than the tension in the reconstructed ligament. Drill holes in the patella should be through the medial rim preferably not exceeding 3.5 mm. Prominence of the reconstructed graft or fixation material over the medial condyle will lead to localized tenderness and is easily avoided by using non prominent fixation devices. There seems to be no progression in patellofemoral degeneration after MPFL reconstructions, in follow up periods of 7–12 years.