Evolution of Technology

Medial Patellofemoral Ligament Reconstruction

Suture anchors are the mainstay of treatment for reconstructing a new MPFL. These suture anchors are a type of orthopaedic implant that attach to the ligament via a suture material and screw into the bone itself. Suture anchors are used initially to attach the new ligament to the patella and then tensioned and secured to the femur. Additionally, in situations where extra support is needed an internal brace, thick band of suture, can be utilized to reinforce the reconstruction. Suture anchors are the ideal fixation method to reattach the ligament as they are able to resist high loads and require minimal drilling into the bone.

Evolution of Procedure

Medial Patellofemoral Ligament Surgery

In the past, soft tissue tightening techniques were used to attempt to strengthen the medial patellofemoral ligament. Unfortunately, these techniques were found to not be as effective in preventing recurrence of dislocation as reconstruction of the MPFL. The key to successful MPFL reconstruction is to reconstruct the ligament back to its original anatomic location on the kneecap (patella) and the thighbone (femur). Proper tensioning is also crucial to allow for the patella to track normally within the femur groove. The goals of reconstruction are to provide stability to the knee and the return the patient back to normal activities. While early MPFL tears may be treated with repair of the ligament; the treatment of choice is generally to reconstruct the ligament with either the patient’s own tissues (autograft) or a donor’s tissue (allograft). There are various ways to secure the graft to the bones including suture buttons, suture bone anchors, and bone interference screws. Risks of this surgery include potentially fracturing the kneecap or recurrent knee instability.

Evolution of Diagnosis

Medial Patellofemoral Ligament Rupture

The medial patellofemoral ligament (MPFL) is one of the crucial structures that works to stabilize the knee. This ligament’s primary role is to keep the patella (kneecap) tracking within its anatomic position during everyday activities. Injury to the MPFL can occur when the patella dislocates or partially dislocates as a result of trauma or athletic events. Once disrupted, patient’s often experience sensations of knee pain, knee instability and recurrent patellar dislocations. Long term complications of patellar instability can include irreversible joint damage, called osteoarthritis. While most patients initially undergo a period of therapy and bracing, failure to improve may lead clinicians to recommend surgical intervention.