AANA Lab Course 913 - Advanced Knee Course-Proximal Patellar Stabilization Procedures_ Technique Options & Tips Faculty Lecture

Proximal Patellar Stabilization Procedures_ Technique Options & Tips Faculty Lecture_ Julie A. Dodds, MD

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This document, authored by Julie A. Dodds, M.D., Associate Clinical Professor at Michigan State University, reviews medial patellofemoral complex (MPFC) anatomy, injury, and reconstruction techniques primarily focusing on the medial patellofemoral ligament (MPFL) and the medial quadriceps tendon–femoral ligament (MQTFL).<br /><br />Anatomical structures discussed include the MPFL, medial patellofemoral complex (MPFC), medial quadriceps tendon femoral ligament (MQTFL), medial meniscopatellar ligament (MMPL), and medial tibiopatellar ligament (MTPL), with the femoral attachment point commonly referencing Schottle’s point. <br /><br />Injuries include femoral or patellar disruption of the MPFC, often associated with osteochondral (OC) fractures. Femoral disruptions have worse nonoperative outcomes (about 30%) compared to patellar, especially in acute cases. In skeletally immature patients, mid-ligament or mixed injuries may respond better to nonoperative management. Surgical repair involves anatomic fixation using suture anchors in bone.<br /><br />Reconstruction options include arthroscopic or open MPFL and/or MQTFL reconstructions typically using gracilis tendon autografts or allografts (~18 cm) or quadriceps tendon turndown grafts (8 cm of central distal quadriceps). Techniques emphasize accurate graft placement at Schottle’s point with femoral fixation via interference screws, prioritizing isometric positioning verified by limited lateral patellar translation at 30 degrees of knee flexion. Over-tightening is a common pitfall leading to loss of flexion and degenerative changes.<br /><br />Postoperative protocol generally allows weight bearing as tolerated, range of motion (ROM) 0–90 degrees by 2 weeks, full ROM by 6 weeks, and return to play at 4–6 months, with use of a hinged brace for 2–4 weeks and patellar stabilizing brace for 3 months.<br /><br />Outcomes show approximately 13% recurrence rate, 94.5% return to sport, and 74% return to same or higher sport level. Complications include patellar fracture, arthrofibrosis, apprehension, pain, and clinical failure, with an overall complication rate around 26%. Critical surgical principles include thorough knowledge of the MPFC anatomy and avoiding graft overtightening to optimize functional outcomes.

Keywords

medial patellofemoral complex

medial patellofemoral ligament

medial quadriceps tendon femoral ligament

MPFL reconstruction

MQTFL reconstruction

Schottle's point

patellar dislocation

ligament injury

arthroscopic surgery

postoperative rehabilitation