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Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

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.
Key words: Medial patellofemoral ligament; Failed medial patellofemoral ligament reconstruction; Trochleoplasty;
3D-CT in patellofemoral surgery


Vicente Sanchis-Alfonso, Erik Montesinos-Berry, Cristina Ramirez-Fuentes, Joan Leal-Blanquet, Pablo E Gelber, Joan Carles Monllau
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