Guidelines for medial patellofemoral ligament reconstruction in chronic lateral patellar instability.

The standard surgical approach for chronic lateral patellar instability with at least two documented patellar dislocations is to stabilize the patella by using an anatomic medial patellofemoral ligament reconstruction with a mini-open technique and a graft that is stronger than the native ligament to compensate for the uncorrected predisposing factors underlying patellar instability. Even though medial patellofemoral ligament reconstruction has evolved notably during the past two decades, many aspects of the surgical technique need to be refined, and more information is needed toward this end. Adequate positioning of the graft on the femur, as well as inducing the appropriate degree of tension, are critical steps for the overall outcome of medial patellofemoral ligament reconstruction. Moreover, it is necessary in some cases to pair medial patellofemoral ligament reconstruction with other surgical procedures to address additional patellar instability risk factors, such as trochlear dysplasia, malalignment, and patella alta.