Importance and radiographic identification of the femoral insertion in medial patellofemoral ligament reconstruction

Abstract

Since biomechanical studies have shown the MPFL as the main restraint against lateral patellar displacement [4, 6], MPFL reconstruction became a widely accepted technique to restore normal patellar tracking and stability [5, 9, 10]. Although the clinical outcome studies after MPFL reconstruction report promising results related to stability, there are some cases, reporting about increased pain or loss of function postoperatively [8, 11, 13, 15, 16]. Main reason therefore seems to be a nonanatomical reconstruction, since the importance of correct graft positioning for ligament reconstruction has been recognized already in 1938 by Palmer [12], and its influence on the clinical outcome is well known in ACL reconstruction [1]. While the patellar insertion, where the medial facet can be prepared completely, even with relatively small skin incisions, the femoral insertion, which is described to be close to the medial epicondyle and the adductor tubercle can be difficult to palpate, not only when covered by soft tissue, but also in skinny patients. © 2010 Springer-Verlag Berlin Heidelberg.