Femoral location critical for successful MPFL reconstruction

In most traumatic patellar dislocations, the medial patellofemoral ligament is either torn or attenuated to the point where it is functionally incompetent. Unfortunately, as the medial patellofemoral ligament is the primary static restraint to lateral patellar translation from 0° to 30°, this injury leaves the patient susceptible to subsequent dislocations. Secondary patellar stabilizers are not substantial enough to compensate for the loss of this powerful restraint, and thus, surgery is often needed for recurrent instability.

While primary repair is an option, the procedure is technically challenging and is fraught with early and late failures. Repair is a good option if the patient has a primary “peel off” lesion of the patella. In these cases, the torn medial patellofemoral ligament (MPFL) can be viewed arthroscopically around the medial side of the patella and is readily seen on MRI. The ligament can be re-attached using sutures and possibly suture anchors. Primary repair on the femur can be done using suture anchors if the surgeon can be confident the MPFL is fully intact at the patella. Fluoroscopy is important to select the correct attachment point. There is considerable potential for this repair procedure to go wrong.

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