Editorial Commentary: Repair or Reconstruct? Addressing Medial Patellofemoral Ligament Insufficiency in the Absence of Morphologic Abnormalities

Abstract

The role of medial patellofemoral ligament (MPFL) repair versus reconstruction in the treatment of patellar instability continues to undergo debate. Repair of the ligament can be technically less demanding with fewer risks of morbidity, whereas reconstruction carries concerns of graft malpositioning or over-tensioning as well as the risk of patellar fracture. Studies directly comparing the 2 procedures in the setting of recurrent patellar instability have consisted of small series or low levels of evidence that inevitably include patients with concurrent morphologic risk factors such as tuberosity malalignment or patella alta, which are known factors that can influence the biomechanical behavior of the MPFL. Heterogeneity in patient-related risk factors and surgical techniques continues to pose limitations in allowing for direct comparisons between procedures. For the treatment of recurrent patellar instability in the setting of no (or concurrently addressed) morphologic abnormalities, MPFL reconstruction has become a common procedure and generally preferred approach. The superior outcomes associated with reconstruction over repair, however, should be qualified with the fact that attention to the critical details of the technique, including graft position and tension, is paramount to success when performing this procedure.

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“…Compared to repair, the reconstruction of the MPFL is reported to yield better midterm outcomes and lower recurrence rates 27 . On the other hand, repair is more strightforward and has a lower risk of stiffness (reduced mobility), also reconstruction may be associated with graft malpositioning or risk of patellar fracture due to overtensioning 28 . In a systematic review of 18 studies, 33.6% of those who underwent surgery could not return to sports, and 33.6% returned 6 months after surgery.…”