Vicente Sanchis-Alfonso, MD, PhD, Department of Orthopedic Surgery, Hospital Arnau de Vilanova Valencia and Hospital 9 de Octubre, C/Valle de la Ballestera, 59, 46015 Valencia, Spain. vicente.sanchis.alfonso@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Feb 18, 2017; 8(2): 115-129 Published online Feb 18, 2017. doi: 10.5312/wjo.v8.i2.115
Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies
Vicente Sanchis-Alfonso, Erik Montesinos-Berry, Cristina Ramirez-Fuentes, Joan Leal-Blanquet, Pablo E Gelber, Joan Carles Monllau
Vicente Sanchis-Alfonso, Department of Orthopaedic Surgery, Hospital Arnau de Vilanova Valencia and Hospital 9 de Octubre, 46015 Valencia, Spain
Erik Montesinos-Berry, Agoriaz Orthopaedic Center, 1632 Riaz and Clinique CIC, 1815 Clarens, Montreux, Switzerland
Cristina Ramirez-Fuentes, Department of Radiology, Hospital Universitario y Politécnico La Fe and GIBI230 IIS La Fe Research Group, 46026 Valencia, Spain
Joan Leal-Blanquet, Joan Carles Monllau, Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
Pablo E Gelber, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08026 Barcelona, Spain
Author contributions: Sanchis-Alfonso V wrote sections 1, 2, 3, 4 and 7 of the paper; Ramírez-Fuentes C wrote section 5; Leal-Blanquet J wrote section 6; Montesinos-Berry E, Gelber PE and Monllau JC edited and corrected the paper; all of the authors have reviewed the final manuscript and have given their approval.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vicente Sanchis-Alfonso, MD, PhD, Department of Orthopedic Surgery, Hospital Arnau de Vilanova Valencia and Hospital 9 de Octubre, C/Valle de la Ballestera, 59, 46015 Valencia, Spain. vicente.sanchis.alfonso@gmail.com
Telephone: +34-96-3179200 Fax: +34-96-3460033
Received: April 27, 2016 Peer-review started: April 28, 2016 First decision: July 5, 2016 Revised: October 31, 2016 Accepted: November 21, 2016 Article in press: November 22, 2016 Published online: February 18, 2017 Processing time: 294 Days and 3 Hours
Abstract
Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.
Core tip: An increasing number of revision surgeries of the reconstructed medial patellofemoral ligament (MPFL) will be seen in the foreseeable future. There are several reasons for this trend: (1) The increasing number of primary MPFL reconstructions; (2) The fact that more and more orthopedic surgeons perform this surgical technique; and (3) The high percentage of patients returning to sport after this type of surgery and thereby put the reconstructed ligament at risk. Our paper tries to answer a crucial question: What must we do to reduce the number of failed MPFL reconstructions? Furthermore, we analyze our approach to dealing with failure after MPFL reconstruction.
