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Complications after MPFL reconstruction
167
Conclusions
MPFL reconstructions seem to give good result
with few complications not withstanding the
varied techniques described in the literature.
There is however certain principles that should
be adhered to prevent complications. The
reconstructed ligament should be tight in
extension and lax in flexion. In cases of severe
patella alta a distalization osteotomy of the
tibial tubercle should be considered to improve
the non isometry of the MPFL. The ligament
should be tensioned in such a way that with
maximum quadriceps contraction the tension
in the patellar tendon should be more than the
tension in the reconstructed ligament to prevent
a permanent extensor lag.
Drill holes through the patella should be as
small as possible preferably not exceeding
3.5mm. These drill holes should be made
through themedial rimof the patella. Transverse
drill holes through the patella should be avoided
to prevent the possibility of transverse fractures
through the patella.
Prominence of the reconstructed graft or
fixation material over the medial condyle will
lead to localized tenderness over this area
which can be annoying to the patient and is
easily avoided by using non prominent fixation
devices.
There seems to be no progression in P-F
degeneration in follow up periods of 7 to
12 years. However, patella degeneration at the
time of the MPFL reconstruction will have a
negative effect on the functional result.
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