In vivo positioning analysis of medial patellofemoral ligament reconstruction.

Background: Several techniques have been described for reconstruction of the medial patellofemoral ligament (MPFL). The anatomical insertion of the MPFL has been defined; however, there are no reports describing the accuracy of femoral graft positioning assessed postoperatively.

Purpose: To analyze our femoral tunnel positioning for MPFL reconstruction in correlation with our clinical results.

Study Design: Case series; Level of evidence, 4.

Methods: The authors reported a prospective series of 29 MPFL reconstructions with a minimum follow-up of 24 months. The tunnel positioning analysis was performed using plain radiographs and magnetic resonance imaging at 1-year follow-up.

Results: Twenty-nine femoral tunnels were analyzed; 20 femoral tunnels (69%) were considered to be in good position on plain radiographs. On magnetic resonance imaging, the authors found 19 femoral tunnels (65%) in a proper location, 5 (17.5%) in a high position, and 5 in an anterior and/or high position.

Conclusion: The study highlights the difficulty of reproducible MPFL reconstruction. The surgical procedure continues to be improved and finding a reliable technique to anatomically place the graft remains challenging. Verifying femoral tunnel placement radiographically may be recommended during surgery.