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Management of overtight medial patellofemoral ligament reconstruction

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope


The clinical presentation of an overtight medial patellofemoral ligament (MPFL) reconstruction can differ depending on whether it is too tight in extension (extensor lag) or too tight in flexion (anterior knee pain and loss of flexion). We report one clinical case of each presentation. Both cases were treated with a percutaneous release of the graft. After the release, both patients regained a full active range of motion without residual symptoms. These complications demonstrate that the adjustment of the graft tensioning as well as its femoral position are critical steps in MPFL reconstruction. This procedure requires training and experience in order to avoid early complications related to malposition or inappropriate tensioning of the graft. A surgical management for these overtight reconstructions is recommended, as it will restore function and range of motion, and prevent late patellofemoral degeneration.

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  1. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220

    Article  PubMed  CAS  Google Scholar 

  2. Andrish JT (2006) Surgical reconstruction of the medial patellofemoral ligament. Tech Knee Surg 5:121–127

    Article  Google Scholar 

  3. Bicos J, Fulkerson JP, Amis A (2007) Current concepts review: the medial patellofemoral ligament. Am J Sports Med 35:484–492

    Article  PubMed  Google Scholar 

  4. Davis DK, Fithian DC (2002) Techniques of medial retinacular repair and reconstruction. Clin Orthop 402:38–52

    Article  PubMed  Google Scholar 

  5. Elias JJ, Cosgarea AJ (2006) Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 34:1478–1485

    Article  PubMed  Google Scholar 

  6. Ellera Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8:335–340

    Article  PubMed  CAS  Google Scholar 

  7. Erasmus PJ, Pollock D, Walters J (2005) Surgical management of patellar instability. SA Orthop J 4:33–35

    Google Scholar 

  8. Fithian DC, Gupta N (2006) Patellar instability: principles of soft tissue repair and reconstruction. Tech Knee Surg 5:19–26

    Article  Google Scholar 

  9. Junnosuke R, Saito S, Yamamoto K (1997) Changes in articular cartilage in experimentally induced patellar subluxation. Ann Rheum Dis 56:677–681

    Article  Google Scholar 

  10. Nomura E, Horiuchi Y, Kihara M (2000) A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 7:211–215

    Article  PubMed  Google Scholar 

  11. Powers CM, Chen Y, Farrokhi S, Lee TQ (2006) Role of peripatellar retinaculum in transmission of forces within the extensor mechanisn. J Bone Joint Surg (Am) 88:2042–2048

    Article  Google Scholar 

  12. Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10:221–227

    Article  PubMed  Google Scholar 

  13. Steinkamp LA, Dillingham MF, Markel MD, Hill JA, Kaufman KR (1993) Biomechanical considerations in patellofemoral joints rehabilitation. Am J Sports Med 21:438–444

    Article  PubMed  CAS  Google Scholar 

  14. Thaunat M, Erasmus PJ (2007) The favourable anisometry: an original concept for medial patellofemoral ligament reconstruction. Knee 14:424–428

    Article  PubMed  Google Scholar 

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Correspondence to Mathieu Thaunat.

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Thaunat, M., Erasmus, P.J. Management of overtight medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 17, 480–483 (2009).

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