J Knee Surg
DOI: 10.1055/s-0037-1604142
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Injuries to the Medial Patellofemoral Ligament: A Review

Jaydev B. Mistry
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Kevin F. Bonner
Department of Orthopedic Surgery and Sports Medicine, Jordan-Young Institute, Virginia Beach, Virginia
,
Chukwuweike U. Gwam
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Melbin Thomas
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Jennifer I. Etcheson
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Ronald E. Delanois
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

18 November 2016

31 May 2017

Publication Date:
18 July 2017 (eFirst)

Abstract

The medial patellofemoral ligament (MPFL) is thought to be the most important medial structure providing restraint to lateral subluxation of the patella. After an initial patellar dislocation, the MPFL is frequently injured and can usually be treated with conservative measures. However, these patients often suffer from recurrent dislocations, which thereby necessitate operative intervention. In the setting of normal anatomy and kinematics, isolated reconstruction of the MPFL is an effective treatment for preventing recurrent dislocations. Various surgical techniques have been described, with differences in fixation and graft selection. The treatment of MPFL injuries should aim to provide patellar stabilization and restore normal kinematics throughout the joint. This review will discuss the following: (1) anatomy of the MPFL, (2) presentation and assessment of MPFL injuries, (3) management of patients with MPFL injuries, and (4) complications following MPFL reconstruction.

Key Points

• Tension is not present in the MPFL unless there is a lateral displacement force, which can be simulated by applying 0.5 N of lateral force.


• MPFL grafts reach maximal length between 20 and 30 degrees.


• Due to varying patient anatomy and radiographic landmarks, length change of the MPFL graft through the ROM is the most important consideration.


• A properly positioned MPFL reconstruction can be placed through immediate full ROM to avoid knee stiffness.


• While there are a variety of fixation methods about the patella, only techniques that do not incorporate bone drilling can avoid fractures.


• Most currently available reports predate the information provided by Tanaka et al[21] and may need modification in the future.


• Overtensioning of the MPFL graft must be avoided.


• Thorough assessment of patient comorbidities is essential in order to maximize outcomes.