Combined Medial Patellofemoral Ligament and Medial Patellotibial Ligament Reconstruction

Abstract

Lateral patellar dislocations are a common, potentially debilitating injury that occurs in young athletes. While the medial patellofemoral ligament (MPFL) is the primary ligamentous restraint to lateral patellar translation, the MPTL and medial patellomeniscal ligament (MPML) also play integral roles in patella kinematics. Biomechanical studies have shown that the MPTL is responsible for nearly 25% of restraint in extension and the combined MPTL/MPML complex provides 46% of the restraint at 90° of flexion. The indications for MPTL reconstruction are evolving, and can include patients with subluxation in extension, flexion instability, children with risk factor for recurrence, knee hyperextension and/or an increased quadriceps vector due to rotational deformities. For reconstruction of the distal medial patellotibial complex, a variety of surgical options are available and are discussed. The authors’ preferred technique is a combined MPFL, MPTL reconstruction using a tibialis anterior allograft. While the long-term outcomes are scarcely described in the literature, the available data suggests that several of these procedures are effective at preventing subsequent dislocations or instability events in select high risk situations, while also providing pain and functional relief to a young and active patient population.