AANA Middle East Arthroscopy Master Course (International)-MPFL Reconstruction

MPFL Reconstruction_ Keys to Success

Pdf Summary

Dr. Robert Hunter presented on Medial Patellofemoral Ligament (MPFL) reconstruction at the AANA Middle East Arthroscopy Master Course in 2019, focusing on treatment strategies for acute patella dislocation and keys to successful surgical outcomes. Patellar instability often results in recurrent dislocations, with MRI and X-rays critical for diagnosis and management decisions.<br /><br />Initial conservative care for acute patella dislocation includes bracing, quadriceps strengthening, range-of-motion exercises, and hip strengthening, with every case warranting MRI evaluation. Surgical indications arise when displaced osteochondral fractures are present or conservative management fails. Arthroscopy can assist in debridement or fracture fixation (ORIF).<br /><br />Lateral retinacular release (LRR) is straightforward and effective for lateral patellar pain without instability but shows poor long-term results for instability or degenerative joint disease. Medial instability, often iatrogenic due to overaggressive lateral procedures or tibial tubercle transfer, is difficult to correct and typically requires further surgery. Therefore, treatment must consider medial-lateral and proximal-distal balance.<br /><br />MPFL reconstruction is a reliable surgical option for patellofemoral instability, restoring medial knee stability. It is performed with graft fixation (often allograft or autograft hamstring tendons), using fluoroscopy to precisely locate femoral insertion. Tensioning at 30° knee flexion is key, allowing physiological graft behavior during knee motion. Literature shows no significant differences in outcomes between autografts and allografts, with low recurrence and high return to activity rates.<br /><br />Surgical failures often stem from incorrect indications, technical errors, or poor patient selection. Non-operative treatment has a variable recurrence rate (15-44%) and can result in activity limitations. Comparisons show surgery may lower recurrence and improve functional scores such as Kujala, especially when tailored to individual alignment and pathology.<br /><br />Medial reefing or imbrication procedures might benefit some patients but have limitations, with some studies showing high residual symptoms or recurrent instability long-term. Overall, MPFL reconstruction combined with appropriate management of alignment and associated pathology offers the best outcomes in treating patellar instability.

Keywords

Medial Patellofemoral Ligament reconstruction

MPFL

patellar instability

acute patella dislocation

arthroscopy

lateral retinacular release

osteochondral fracture fixation

MRI diagnosis

graft tensioning

surgical outcomes