MPFL reconstruction

Lecture 6 Primary patellofemoral dislocations are common. It results from quadriceps contraction across a flexed, valgus knee with the weightbearing tibia externally rotated compared to the femur. The dislocation usually reduces spontaneously or with muscle relaxing drugs. In most patients, non-operative management produces satisfactory outcome. Conservative management focuses on concentric exercises to strengthen the quadriceps, and especially the vastus medialis, to prevent further instability. If the dislocation recurs after a trial of rehabilitation, operative intervention should be considered, with the aim of restoring the soft tissue anatomy to normal. Ninety-four per cent of patients suffer a tear to the medial patellofemoral ligament (MPFL) following a patellar dislocation. We perform transverse patella double tunnel technique to reconstruct the MPFL using a free autologous gracilis or semitendinous graft. MPFL reconstruction using hamstring tendon passed through a double patellar transverse bony tunnel technique is a safe, reliable management option for recurrent patellar dislocation in patients without any predisposing anatomic factors.