Management of Patellofemoral Instability: Stabilization, Cartilage Restoration, Resurfacing, and Arthroplasty (AANA19)-MPFL vs MQTFL Reconstruction-Dr. Miho Jean Tanaka, M.D., M.A.

Video Transcription

Video Summary

The lecture discusses the medial patellofemoral ligament (MPFL) and its role in stabilizing lateral patellar translation, particularly after dislocations. Recent studies reveal variability in the MPFL's anatomy, including its attachment to the quadriceps tendon, leading to the concept of a medial patellofemoral complex (MPFC). Traditional single-bundle reconstructions mostly focus on patellar attachment, but evidence suggests the graft attachment midpoint is more proximal, near the quadriceps-patella junction. Proper femoral tunnel placement is critical to avoid complications such as increased patellofemoral stresses. Reconstruction options include patellar or quadriceps fixation, with the quadriceps tendon approach (MQTFL) reducing patellar fracture risk and possibly tolerating graft overtightening better. Double-bundle reconstructions combining both attachments are emerging but lack biomechanical validation. Key surgical considerations include careful graft tensioning (setting to length rather than overtightening) and addressing coexisting anatomic factors influencing instability. While MPFL reconstruction is established, further outcome studies on MPFC and MQTFL approaches are needed.

Asset Caption

Instructional Course Lecture: Management of Patellofemoral Instability: Stabilization, Cartilage Restoration, Resurfacing, and Arthroplasty

Keywords

medial patellofemoral ligament

MPFL anatomy variability

medial patellofemoral complex

MPFL reconstruction techniques

quadriceps tendon fixation

patellofemoral instability management