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Lateral patellofemoral ligament reconstruction for medial patellar iatrogenic instability
OVERVIEW
Chapter synopsis
Important points
Indications
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Patients with medial patellar subluxation or dislocations
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Patients with excessive lateral patellar laxity undergoing medial patellofemoral ligament reconstruction
Relative contraindications
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Unaddressed symptomatic patellofemoral chondral damage
Surgical technique
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Soft tissue-based reconstruction with a semi-tendinosis allograft
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Along the extensor mechanism, the graft is fixated through the distal aspect of the quadriceps tendon and proximal aspect of the patellar tendon
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The graft is fixated through the iliotibial (IT) band adjacent to the lateral epicondyle on the femur
Clinical/surgical pearls
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Check for patellar eversion and tilt after inserting one suture into both the proximal and distant bundles of the LPFL graft, the tension of the graft can be adjusted accordingly
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When suturing the graft, sutures should be placed near the patella or femur to prevent entrapment of the capsule
Clinical/surgical pitfalls
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Failure to correct other concerning pathoanatomy or cartilage pathology
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Overtensioning the LPFL graft can lead to lateral patellar maltracking and lateral patellar chondral damage
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Restriction of flexion postoperatively
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