Medial patellofemoral ligament reconstruction fails to correct mild patella alta in cases of patellofemoral instability—a case-control study

  • Philip P. RoesslerEmail author
  • Matthias D. Wimmer
  • Cornelius Jacobs
  • Rahel Bornemann
  • Thomas Stein
  • Matthias Lahner
Original Paper



Medial patellofemoral ligament reconstruction (MPFL-R) is the gold standard in patella soft tissue surgery for patellofemoral instability. Although claimed, recent reports indicate that MPFL-R may fail to distalize the patella in mild cases of patella alta. The present study is a retrospective case-control study to compare radiographic patella height between MPFL-R and historical Insall’s proximal realignment (IPR) pre- and post-operatively with respect to distalization and assess redislocation rates at a mid-term follow-up.


Sixty-four patients were age/sex matched (1:1), yielding 32 patients for group 1 MPFL-R (cases) and 32 patients for group 2 IPR (controls). Insall-Salvati, Blackburne-Peel and Caton-Deschamps indices were analyzed for differences pre- and post-operatively. An additional inter-rater reliability analysis was performed by means of intra-class correlation (ICC). Redislocation rates were considered as treatment failures in this study.


ICC was excellent for all three patella indices. MPFL-R failed to show significant differences if compared to IPR with respect to distalization in mild stages of patella alta. Moreover, redislocation rates significantly favored MPFL-R (3.1%) over IPR (12.5%; p < 0.0001).


MPFL-R has become a popular option to restore native patellofemoral biomechanics after ligament rupture. However, the procedure’s potential to correct concomitant patella alta should not be overestimated and indications considered carefully.


Medial patellofemoral ligament Proximal realignment Patella alta Patella height indices 



The authors wish to thank Dr. P. Johannes Wagenhäuser, MD, for his kind support in obtaining the radiographic datasets.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumatologyUniversity Hospital BonnBonnGermany
  2. 2.Department of Sporttraumatology, Knee and Shoulder-SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurtGermany
  3. 3.Joint Center HildenRuhr-University BochumBochumGermany

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