Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Figure 4 Patient of 19 years of age with severe anterior knee pain and lateral patellar instability. Three years ago, he had a MPFL reconstruction with a single bundle semitendinosus tendon graft. During the physical examination, there was no disorder in patellofemoral tracking. With the patient under general anesthesia, the patella could not be dislocated beyond 40º of knee flexion. We note that the femoral tunnel of the MPFL reconstruction is too anterior, which is a serious mistake. There is also severe chondropathy of the articular surface of the patella. We can see that the distance between the patellar fixation point and the femoral fixation point increases with knee flexion. Clinically, this causes an increase in patellofemoral pressure during knee flexion that could justify the severe patellar chondropathy the patient has. The anatomic MPFL reconstruction, using the contralateral semitendinosus tendon with a double bundle technique, led to the resolution of all the patient’s symptoms. MPFL: Medial patellofemoral ligament.