Medial Patellofemoral Complex Advancement for Recurrent Lateral Patellar Instability and Selective Acute Primary...

Medial patellofemoral complex (MPFC) is considered as the primary medial patellar restraint and has a static, as well as dynamic, component. MPFL reconstruction (MPFL-R) restores only the static component of MPFC, is associated with multiple technical concerns, and has a steep learning curve. Need for physeal sparing techniques and relatively high rates of complications including patella fracture are some other concerns with MPFL-R. We propose a simple procedure for advancement of MPFC onto patella, which is indicated in most of the recurrent lateral instabilities (with a positive lateral glide test result and an intact MPFL on magnetic resonance imaging). The procedure is also indicated in selective acute primary dislocations-those with associated chondral lesions and magnetic resonance imaging-documented isolated patellar side avulsion/injury. MPFC advancement is a more anatomical procedure that also restores dynamic medial checkrein of patella and can be performed even by a novice surgeon. MPFC advancement is devoid of the multiple technicalities of MPFL-R, does not require intraoperative imaging or any postoperative immobilization, and renders complications like donor graft-site morbidity and patella fractures irrelevant. It requires no modifications in patients with open physes and can be performed in isolation or with other procedures as per à la carte principle.