Technical failure of medial patellofemoral ligament reconstruction

In patients with chronic patellofemoral instability who have normal alignment and deficient proximal medial restraints, medial patellofemoral ligament (MPFL) reconstruction is a good option to treat patellar instability. However, medial subluxation, medial patellofemoral articular overload, and recurrent lateral instability are possible when the graft is positioned non-anatomically. The clinical presentation of MPFL femoral tunnel malpositioning has not been highlighted in the literature. We have had 5 patients referred to us after a malpositioned femoral MPFL graft led to disabling symptoms and a need for revision surgery. This report highlights the effects of a malpositioned graft and describes strategies to identify the anatomic MPFL insertion during surgery.