Medial patellofemoral ligament reconstruction.

The medial patellofemoral ligament has been recognized as the structure primarily responsible for preventing patellar subluxation or dislocation.1-3 Anatomic dissection studies identified the medial patellofemoral ligament as a band of tissue connecting the femoral medial epicondyle to the proximal part of the medial edge of the patella (Figure 1).1-6 Imaging studies7-11 and surgical exploration reports7,10,12,13 have shown that medial patellofemoral ligament injury is associated with patellar dislocation. These studies concluded that insufficiency of the medial patellofemoral ligament is the major factor in recurrent patellar dislocation. However, few reports are found in the literature describing details of reconstruction of the medial patellofemoral ligament13-19 to treat recurrent patellar dislocation. This article presents a simple and reproducible technique for reconstruction of the medial patellofemoral ligament using autogenous tissue following the basic principles of all ligament reconstruction: ● Selection of a sufficiently strong and stiff graft, ● Isometric graft placement, ● Correct tension, ● Adequate fixation, and ● No condylar rubbing or impingement. MATERIALS AND METHODS Reconstruction of the medial patellofemoral ligament has been performed in our institution since 1982 in 172 patients. Adductor longus tendon was used in 107 cases whereas quadriceps tendon was used in 65 cases. Quadriceps tendon graft is preferred for cases with trochlear dysplasia based on the concept that a stronger structure is needed to compensate for inadequate support provided by a flat trochlea.