ICL 306: Avoiding Complications in Patellofemoral Instability Surgery: MPFL Reconstruction-Patella Fx after MPFLR (tips to avoid) and How to Avoid Errors of Over-tensioning

Patella Fx after MPFLR (tips to avoid) and How to Avoid Errors of Over-tensioning

Video Transcription

Video Summary

The talk addresses patellar fractures after medial patellofemoral ligament (MPFL) reconstruction and how to avoid overtension errors. Patellar fractures occur in about 1% of cases, often due to transverse bone tunnels creating stress risers that weaken the patella. Various techniques to minimize fracture risk include avoiding tunnels by using suture anchors or soft tissue attachment methods, such as fascial slings or quadriceps tendon turn-downs. Attention to preserving blood supply is crucial. To prevent over-tensioning, the graft should be set "out to length" anatomically, typically fixed around 20–30 degrees of knee flexion, allowing the graft to be lax during flexion to avoid cartilage overload and stiffness. Proper anatomical placement of femoral and patellar attachments is critical; malpositioning can increase medial patellofemoral contact pressures and risk arthritis long-term. The speaker’s evolved technique includes precise identification of attachment sites, using expandable fixation devices to avoid graft compression errors, and intraoperative length testing with the knee's range of motion to ensure anatomic, non-restrictive reconstruction.

Asset Caption

Presented by Jack Farr, II, MD

Keywords

patellar fractures

MPFL reconstruction

overtension errors

suture anchors

anatomic graft placement