Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 7, pp 979–984 | Cite as

Femoral tunnel widening is associated with tunnel malposition but not with clinical failure after medial patellofemoral ligament reconstruction with a free gracilis tendon graft

  • Karl-Friedrich Schüttler
  • A. Hoeger
  • T. J. Heyse
  • J. Figiel
  • N. Timmesfeld
  • T. Stein
  • E. Ziring
  • T. Efe
Arthroscopy and Sports Medicine



MPFL reconstruction is widely and successfully used for treating patella instability, either as a standalone procedure or in combination. Although different techniques allow for MPFL reconstruction, the use of a free tendon graft is one of the most commonly used. The phenomenon of tunnel widening or tunnel enlargement is well described in ACL reconstruction, but so far only little effort has been put into evaluating this phenomenon after MPFL reconstruction.

Materials and methods

Patients who received an MPFL reconstruction with a free gracilis tendon graft were identified by review of patient files. Additional clinical examination and magnetic resonance imaging were performed to assess tunnel enlargement and clinical outcome.


Fifty-one knees of 49 patients (34 female, 17 male) with a mean follow-up of 3.0 ± 1.4 years were included in this study. Mean age at the time of surgery was 22.6 ± 8.5 years. Mean Tegner score decreased from preoperative 5.3 ± 2.0 to 4.0 ± 1.4 postoperative. Postoperative IKDC and Kujala scores were 74 ± 16 and 80 ± 15, respectively. Twenty-three patients showed a tunnel enlargement at follow-up examination. Of these 23 patients, 20 showed a tunnel that was positioned too proximal, whereas only 13 of the 28 patients showing no enlargement had a tunnel that was positioned too proximal (p = 0.0033). Interestingly, patients showing a tunnel enlargement at follow-up examination also showed significantly better Kujala (84 ± 12 vs. 75 ± 16; p = 0.03) and IKDC scores (80 ± 7 vs. 70 ± 19; p = 0.02) when compared to the non-enlarged group.


Tunnel enlargement after MPFL reconstruction with a free gracilis tendon graft seems to be connected to mechanical overload due to a proximal malposition of the femoral tunnel. Interestingly, this did not influence clinical outcome as patients with tunnel enlargement showed better Kujala and IKDC scores.


MPFL reconstruction Tunnel widening Tunnel enlargement Malposition Patella instability 


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Karl-Friedrich Schüttler
    • 1
  • A. Hoeger
    • 1
  • T. J. Heyse
    • 1
  • J. Figiel
    • 2
  • N. Timmesfeld
    • 3
  • T. Stein
    • 4
    • 5
  • E. Ziring
    • 1
  • T. Efe
    • 1
    • 6
  1. 1.Center of Orthopedics and Trauma SurgeryUniversity Hospital MarburgMarburgGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity Hospital MarburgMarburgGermany
  3. 3.Institut of Medical Biometrics and EpidemiologyUniversity MarburgMarburgGermany
  4. 4.Department of Sporttraumatology, Knee- and Shoulder-SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurtGermany
  5. 5.Department of Sports ScienceUniversity of BielefeldBielefeldGermany
  6. 6.Orthopaedicum LichLichGermany

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