Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients

Abstract

Failure to consider additional risk factors, technical intra-operative errors and inappropriate patient selection were identified as reasons for revision surgery after MPFL reconstruction. Identifying the potential causes of failure can help to treat and possibly prevent future complications.

Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents

“…Most of the authors support the theory of a combination of ischemic necrosis and repeated micro-trauma [1,[3][4][5]. This very rare lesion is observed in 70 % of cases during the second decade of life, predominantly in male and occurred in the context of sports practice [6,7]. The functional prognosis can be compromised in the absence of early diagnosis of the lesion.…”

“…The functional prognosis can be compromised in the absence of early diagnosis of the lesion. Several surgical treatments (resection of the fragment, fixation with screws or pins, transchondral perforation, chondrocyte grafts) were reported in the literature on isolated cases or limited series with a short-term follow-up [1,[6][7][8][9][10][11][12][13][14]. Autologous osteochondral mosaicplasty was described in the treatment of cartilage lesions of the femoral condyles [15,16].…”

Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome

“…However in the presence of increased femoral anteversion, reconstruction of the MPFL without concomitant correction of the torsional deformity may be at increased risk of failure since the laterally-directed patellofemoral joint forces are unaddressed and lead to increased tension across the MPFL reconstruction [22,24].…”

“…In patients with severely increased femoral anteversion however, MPFL reconstruction as an isolated procedure might not be sufficient, as it does not address the underlying increased femoral torsion [22,24]. Additionally there is concern over residual or ongoing patellofemoral pain because of increased forces in the patellofemoral joint.…”

Strategies for Reconstruction of the Medial Patellofemoral Ligament

“…60 In a recent study analyzing 19 unsuccessful MPFL reconstructions undergoing revision, failure to consider additional risk factors and technical errors were identified as the main causes for failure. 61 Of the 7 technical errors, 3 involved positioning of the femoral tunnel too proximally and anteriorly, and 4 involved overtensioning of the graft. In all cases these errors caused medial pain and loss of flexion.…”