ICL 306: Avoiding Complications in Patellofemoral Instability Surgery: MPFL Reconstruction-Questions and Answers

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Video Summary

The session discussed medial patellar instability, especially in patients with or without prior surgery. Medial instability is uncommon without prior lateral release surgery but can be significant in hyperlax individuals and adolescents. Examination typically occurs in full extension, though some experts recommended assessing at 20-30 degrees of flexion to detect instability. Reconstruction approaches usually preserve soft tissue attachments, using the iliotibial band for reinforcement without bony anchors. Functional instability, often missed, may cause sudden leg giving way and requires careful clinical reproduction of symptoms. Hyperlax patients might benefit from MPFL reconstruction using allografts, avoiding overtightening to maintain normal knee mechanics. Postoperative rehab emphasizes early knee motion and protected weight-bearing, especially after osteotomies. For medial patellofemoral arthritis, unloading osteotomies like lateralization or anteriorization may help, although these are challenging cases. In skeletally immature patients, soft tissue grafts avoid physeal injury with cautious surgical planning. Overall, precise diagnosis and tailored treatment, combining surgical and rehab strategies, yield the best outcomes.

Keywords

medial patellar instability

MPFL reconstruction

hyperlaxity

postoperative rehabilitation

unloading osteotomies