The Role of Medial Patellofemoral Ligament Repair and Imbrication
Repair, reefing, and advancement of the medial patellofemoral ligament (MPFL) and medial retinacular structures can be performed as an isolated procedure or in conjunction with distal realignment procedures for patients with patellar instability. Although various operative techniques have been described, understanding the appropriate clinical indications and MPFL injury patterns ultimately determines the success or failure of the procedure. MPFL repair is best indicated in the acute setting, particularly if there is a patella- or femoral-based avulsion. If MPFL repair is being considered, and there is no evidence of avulsion on plain radiographs, magnetic resonance imaging can be used to examine the pattern and extent of the MPFL injury. In cases of chronic patellar instability, medial retinacular reefing or imbrication is best considered in conjunction with other procedures that address common pathology associated with chronic instability. These procedures include distal realignment, trochleoplasty, and distal femoral osteotomy.
Conclusion
Careful patient selection is the most important element for successful MPFL repair or imbrication. MPFL repair is most reliably used in patients with clear patella- or femoral-sided avulsions and in patients with a first-time patellar dislocation and a clear surgical indication, such as a large osteochondral fragment. Proximal realignment procedures, which include MPFL reefing, imbrication, and advancement, typically are not performed in isolation, as other osseous procedures are often needed concomitantly in order to preserve the checkrein effect provided by proximal realignment procedures. As is the case with MPFL reconstruction, understanding the relevant anatomy and avoiding overtensioning of the medial structures during MPFL repair or proximal realignment procedures are crucial.
Am J Orthop. 2017;46(2):87-91. Copyright Frontline Medical Communications Inc. 2017. All rights reserved.
