Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Figure 5 Patient 28-year-old, with very severe anterior knee pain and lateral patellar instability. During the physical examination, we saw a clear patellofemoral mal-tracking and we were able to dislocate the patella laterally beyond 60º of knee flexion. She has been operated on several times over the last 8 years: A lateral retinacular release, proximal realignment, an ostetotomy for medialization of the tibial tubercle and MPFL reconstruction. We note that the femoral tunnel is too proximal and anterior. The distance between the patellar fixation point and the femoral fixation point increases significantly with knee flexion. Clinically, this increases patellofemoral pressure significantly during knee flexion, which could explain the severe patellofemoral osteoarthritis the patient has. In this specific case the pain disappeared after a sulcus deepening trochleoplasty. We performed an anatomic double bundle MPFL reconstruction with a semitendinosus tendon graft and the lateral patellar instability also disappeared completely. MPFL: Medial patellofemoral ligament.