Surgical reconstruction of the medial patellofemoral ligament

Various treatments for patellofemoral instability have been proposed, such as lowering or medialization of the tibial tubercle, division of the lateral retinaculum, plication of the medial retinaculum, lowering of the vastus medialis, and trochleoplasty. However, it has been difficult to analyze the outcomes of each technique because they are often performed in combination. Recent anatomical and biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the primary stabilizer of the patella between full extension and 30° flexion. For this reason, reconstructing this ligament is relevant, reinforced by promising early clinical results. MPFL reconstruction techniques differ in the graft used and the fixation method. They will be described here as a function of their fixation method, either into bone or soft tissue. The technical challenges, advantages and disadvantages of these different techniques are reviewed in detail, along with the postoperative rehabilitation protocol. Strict technique is needed to prevent postoperative complications, with flexion contracture due to excessive graft tension being the most common complication. Recurrence of the instability is rare after surgery, proof of the dependable nature of these reconstruction procedures.