Lateral Patellofemoral Ligament Reconstruction Remains Poorly Defined: A Review from Anatomy to Surgical Management

» Lateral patellofemoral ligament (LPFL) deficiency is an under-recognized but clinically relevant cause of medial patellar instability, most commonly following excessive lateral retinacular release, though traumatic and atraumatic etiologies have also been described. » Diagnosis remains primarily clinical and is characterized by medial apprehension, pain in early knee flexion, and excessive medial translation, with imaging serving an adjunctive role in excluding osseous contributors and confirming direction-specific instability. » Anatomic LPFL reconstruction restores lateral restraint and has demonstrated consistent short-term to mid-term improvements in stability and patient-reported outcomes, although available evidence is limited to case series, technical reports, and biomechanical investigations. » LPFL reconstruction techniques vary substantially, but soft-tissue patellar fixation strategies may reduce patellar bone violation and potential fracture risk while attempting to restore lateral patellar restraint.