Medial Patellofemoral Ligament Reconstruction and Patellar Instability Management

The medial patellofemoral ligament (MPFL) is the primary soft-tissue restraint preventing lateral displacement of the patella. Disruption of the MPFL, whether through acute dislocation or chronic overload, leads to recurrent instability, pain and early chondral damage. Initial management emphasises targeted physiotherapy to strengthen the quadriceps and hip abductors, alongside bracing; however, non-operative strategies fail in a substantial subset of patients. Surgical reconstruction of the MPFL has therefore become central to restoring patellar stability. Techniques aim to replicate the native ligament’s anatomy, using autologous hamstring tendons or allografts, with emerging interest in synthetic graft materials. Single-bundle and double-bundle reconstructions have been developed to reproduce the ligament’s broad patellar attachment and its fan-shaped femoral origin. Adjunct procedures, such as tibial tubercle transfer or trochleoplasty, are considered in the presence of malalignment or trochlear dysplasia. Accurate positioning of femoral and patellar fixation points and controlled graft tension are critical to avoid over-constraint and maintain a functional range of movement. Postoperative rehabilitation focuses on early mobilisation, graduated loading and dynamic stability exercises to minimise recurrence and facilitate return to activity. Advances in imaging, biomechanics and computational modelling are refining patient selection, surgical technique and personalised planning to achieve durable, anatomically faithful outcomes.

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Medial Patellofemoral Ligament Reconstruction and Patellar Instability Management publication trend

The graph below shows the total number of articles in medial patellofemoral ligament reconstruction and patellar instability management across all publications each year (not limited to Nature Index journals).

Technical terms

Medial Patellofemoral Ligament (MPFL): A fibrous band connecting the medial femoral condyle to the superomedial patella, serving as the chief restraint against lateral patellar displacement.

Graft: Biological or synthetic material used to reconstruct the MPFL, harvested from the patient (autograft), a donor (allograft) or manufactured as a synthetic substitute.

Patellar Instability: The tendency of the patella to subluxate or dislocate laterally, often due to ligamentous insufficiency, bony malalignment or trochlear dysplasia.

Digital Twin: A computational replica of an individual’s patellofemoral joint, used to simulate surgical interventions, graft mechanics and postoperative function.

References

1. The Use of Synthetic Graft for MPFL Reconstruction Surgery: A Systematic Review of the Clinical Outcomes. Medical Sciences (2023).
2. Use of patellofemoral digital twins for patellar tracking and treatment prediction: comparison of 3D models and contact detection algorithms. Frontiers in Bioengineering and Biotechnology (2024).
3. Biomechanical comparison of single- and double-bundle medial patellofemoral ligament reconstruction. Journal of Orthopaedic Surgery and Research (2017).
4. Medial Patellofemoral Ligament Reconstruction: A Comprehensive Review. Knee Surgery & Related Research (2015).
5. Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy. Knee Surgery, Sports Traumatology, Arthroscopy (2016).