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MPFL reconstruction

156 citationsUpdated Sep 2026

Overview

Medial patellofemoral ligament (MPFL) reconstruction serves as a durable surgical treatment for first-time or recurrent patellar instability, demonstrating relatively low rates of recurrent instability and failure at up to 10 years [42, 76]. The procedure yields favorable midterm outcomes that are maintained at 5 years [9], with functional results remaining favorable as complication and failure profiles improve with widespread implementation [78]. Isolated MPFL reconstruction achieves good short-term clinical results even in challenging cohorts with multiple severe anatomical risk factors, such as severe trochlear dysplasia, increased tibial tuberosity–trochlear groove distance, patella alta, and lower extremity torsion deformities [2]. In such high-risk populations, 93% of patients returned to sports, with a redislocation rate of 7.4% [2]. While MPFL repair and reconstruction provide similar clinical results, return to play rates, and reoperation rates [6], reconstruction may offer improved midterm clinical outcomes and a decreased recurrence rate compared with repair [10].

Graft selection and fixation techniques present multiple viable options without significant differences in failure rates, patient-reported outcomes, pain, or complications between allograft and autograft [24, 30]. Allografts represent a feasible alternative to traditional autograft in selected patients [71] and may be performed safely in the pediatric and adolescent population with good midterm outcomes, few complications, and low recurrent instability [29, 60]. Both suture anchor and interference screw techniques for patellar fixation provide greater ultimate failure loads than the native MPFL [27]. Various operative approaches, including the "double-socket" technique, divergent patellar transverse 2-tunnel technique, and use of semitendinosus or pedicled quadriceps tendon grafts, yield successful results in well-selected groups with minimal complications [47, 33, 210]. Open and radiographic localization of the femoral graft position offer similar outcomes and complication rates [3].

Concomitant procedures, such as lateral retinacular release or tibial tubercle transfer, do not significantly alter functional outcome scores or failure rates compared with isolated reconstruction [5, 8]. The addition of an appropriately indicated tibial tubercle osteotomy is both safe and effective [39], and combined MPFL and MPTL reconstruction in young adults results in significant improvement in subjective knee function with minimal risks, though preinjury activity levels are not consistently restored [4]. Both MPFL reconstruction and tibial tubercle transfer allow quick recovery, low rates of instability, and minimal risk of complication [28]. An increase in previously reported thresholds for adding a bony procedure can result in successful outcomes in some patients [77]. Further investigation is needed to determine safe and effective guidelines for return to play after MPFL reconstruction and repair [1].

Anatomy & Pathophysiology

Medial Patellofemoral Complex Anatomy

The medial patellofemoral complex (MPFC) comprises fibers attaching to the patella, specifically the medial patellofemoral ligament (MPFL), and the quadriceps tendon, known as the medial quadriceps tendon femoral ligament (MQTFL) [236]. The midpoint of the MPFC is consistently located at the junction of the medial quadriceps tendon with the articular surface of the patella [236]. The MPFL is a reinforcing band extending from the patella that reinforces the anteromedial portion of the joint capsule [88]. It runs from the patella near the junction of the middle and superior thirds to the medial femoral epicondyle [88]. The MPFL is considered more important for patellar stability than other medial structures [88].

Cadaveric data indicate that the attachment sites of MQTFL fibers vary considerably, with some specimens attaching exclusively to the patella and others solely to the quadriceps tendon [35]. Inferior-straight MQTFL fibers insert on the patella, while superior-oblique fibers attach to the quadriceps tendon [35]. There is anisometry between the MQTFL bundles throughout knee motion [35].

Femoral Landmarks: The medial femoral epicondyle is the most anterior and distal osseous prominence of the medial femoral condyle [85]. The adductor tubercle is located proximal and posterior to the medial epicondyle [85]. The gastrocnemius tubercle is located slightly distal and posterior to the adductor tubercle [85].

Patellar and Femoral Osseous Anatomy

The patella is the largest sesamoid bone in the body, averaging 2.5 cm in thickness [85, 99]. It possesses the thickest articular surface in the body, approximately 5 mm in the midportion and 2 mm on the sides [85]. The patellar articular surface contains a vertical central ridge that separates the broader lateral facet from the medial facet [85]. A smaller, more medial facet called the odd facet is present on the distal medial patella and articulates in deep flexion of the knee [85, 99]. The lateral trochlear facet resists lateral subluxation of the patella [99]. The sulcus terminalis is a transverse ridge extending from the oblique facets of the femoral trochlea that is deeper on the lateral condyle than on the medial condyle [99].

The medial femoral condyle is larger and projects farther posteriorly and distally than the lateral condyle [85]. Conversely, the lateral femoral condyle projects farther anteriorly and is wider in the medial-lateral direction than the medial condyle [85].

Patellofemoral Biomechanics and Kinematics

The patella increases the lever arm for knee extension [100, 101]. It bears half the body weight with normal walking [100, 101] and seven times the body weight with squatting and jogging [100, 101]. Patellofemoral loads are proportional to the ratio of quadriceps force to knee flexion [100, 101]. In descending stairs, compressive force at the patellofemoral joint reaches two to three times body weight [100, 101]. The quadriceps produces maximum anterior force on the tibia at 0 to 60 degrees of knee flexion [100, 101].

MPFL grafts tend to carry minimal load beyond 30 degrees of knee flexion during functional activities [192]. Radiographic measures of patellar tracking and alignment change with knee motion [138]. In knees with instability symptoms, radiographic measures of tracking and alignment are most abnormal at lower flexion angles [138]. MPFC fibers demonstrate increased length changes in knees when a greater number of morphological risk factors for patellar instability are present [202]. Increased MPFC fiber length changes worsen in the setting of nonanatomic configurations [202]. Medial patellar instability following lateral retinacular release occurs during the unloading phase of gait when passive structures guide the patella [193].

Injury Pathophysiology and Reconstruction Biomechanics

Acute lateral patellar dislocation results in injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella [13]. The understanding of the complexity of the medial patellar stabilizers continues to evolve [31]. Restoring the MPFC rather than a single ligament provides a more accurate reproduction of native biomechanics [35]. Combined MPFL and MQTFL reconstruction respects the layered anatomy of the medial restraints and more closely replicates physiologic restraint across the range of knee motion [35].

Reconstruction Tension and Kinematics: Anatomically positioned MPFL reconstruction with 2-N tension fixed at 30 or 60 degrees of knee flexion restored joint contact pressures and tracking [123]. A pretension of 2 N was found to restore the knee joint closest to normal patellofemoral kinematics [131]. Anatomic MPFL reconstruction resulted in a favorable graft length change range of less than 2 mm at 0 to 90 degrees of knee flexion, which was close to isometric graft behavior [160]. However, anatomic reconstruction of the MPFL may not fully restore patellofemoral pressure distributions compared to the native knee [161].

Dynamic vs. Static Reconstruction: Patellar contact pressures after dynamic MPFL reconstruction were similar to those of the native knee, whereas static reconstruction resulted in greater pressures [182]. Static MPFL reconstruction potentially increases the risk of patellofemoral osteoarthritis in the long term [182]. MPFL reconstruction at various angles of knee flexion and pretension levels showed no statistically significant differences in patellofemoral pressure compared to the native state [198]. Kinematics were not optimal with the use of a smaller tubular graft compared to the native fan-shaped MPFL [147].

Anatomic Constraints and Phenotypes: MPFL reconstruction restores patellar kinematics and contact mechanics to the intact state when the tibial tubercle is in an anatomic or 5-mm lateralized position [153]. MPFL reconstruction fails to restore patellar kinematics and contact mechanics to the intact state when the tibial tubercle is lateralized by 10 mm or 15 mm [153]. In simulated multidirectional motion, MPFL reconstruction did not sufficiently constrain the patella for some knees [188]. Distinct anatomical phenotypes underlie dynamic patellar maltracking [149]. The altered function of the patellar tendon in anterior cruciate ligament deficiency resulted in altered patellar tracking and patellofemoral cartilage contact [183].

Classification

Dejour and Le Coultre: This classification defines trochlear dysplasia severity as no dysplasia, low-grade dysplasia (Type A), or high-grade dysplasia (Types B, C, D) based on true lateral radiographs and axial MRI scans [53]. Type A is characterized by a visible crossing sign on lateral radiographs and a symmetric but shallower trochlear groove with a sulcus angle greater than 145° on axial images [53]. Type B entails a crossing sign and a supratrochlear spur on lateral radiographs, with a flat trochlea on axial images [53]. Type C is identified by a crossing sign and double contour on lateral radiographs, with lateral facet convexity and medial facet hypoplasia on axial images [53]. Type D involves a crossing sign, supratrochlear spur, and double contour on lateral radiographs, with a "cliff" on axial images due to asymmetry of the lateral and medial femoral trochlear facets [53]. On axial MRI scans, the classification depicts a normal trochlea, Dejour A (shallow >145° trochlea), Dejour B (flat trochlea), Dejour C (dominant and convex lateral trochlear facet), and Dejour D (absence of a medial trochlear facet) [229].

Insall and Salvati: Patellar height is determined on lateral radiographs using the method described by Insall and Salvati, which has been shown to be the most reliable [53].

Wiberg: Grades IV and V of the Wiberg classification are used to define patellar dysplasia in the context of MPFL reconstruction patient selection [217].

Outerbridge: The Outerbridge classification is used to grade femoral and patellar cartilage during arthroscopy for MPFL reconstruction [216].

ICRS: The ICRS classification system is used to specify the grade of cartilage injury in studies evaluating concomitant cartilage restoration with MPFL reconstruction [40].

Iwano: The Iwano classification is used to grade patellofemoral arthritis, where grades 1 or 2 are considered mild [235].

Kellgren–Lawrence: The Kellgren–Lawrence classification is used to assess osteoarthrosis in radiographs of patients undergoing MPFL reconstruction [201].

Clinical Presentation

Preoperative Assessment and Indications

MPFL reconstruction is indicated specifically when there is loss of the medial retinacular patella stabilizer due to recurrent lateral patella dislocations [141]. For the procedure to be indicated, MPFL laxity must be documented by physical exam and/or stress radiographs and/or arthrometrer testing [141]. The procedure is not indicated for isolated patellofemoral pain, excessive patellofemoral lateral tilt and/or translation without instability, or patellofemoral arthritis [141]. An exam under anesthesia and arthroscopy can be used to document laxity without guarding or apprehension [141]. Arthroscopy is most helpful to stage cartilage lesions during the preoperative workup [141]. Typically, arthroscopy shows excessive lateral tilt and translation through a passive range of motion due to medial retinacular laxity with the joint distended [141]. However, lateral maltracking cannot be judged based on the arthroscopic view of excessive lateral tilt and translation [141]. Diagnostic arthroscopy with MPFL reconstruction may result in findings not previously appreciated on MRI [45]. Substantial cartilage injuries are present in 56% of patients who undergo primary isolated MPFL reconstruction, with medial patellar lesions being the most common [55, 62]. Increased age at surgery is associated with an increased risk of substantial cartilage damage [136].

Anatomical Considerations and Surgical Decision-Making

If bony malalignment, trochlear dysplasia, or patella alta is identified during the preoperative workup, an isolated MPFL reconstruction must not be performed [121]. The MPFL is most often used alone without a distal realignment or a trochleoplasty when the bony constructs are normal or near normal [141]. A tubero-sulcus angle of 1.4 is a threshold for performing a distal tibial tubercle transfer, aiming for a post-op measurement of 1.1-1.2 [141]. The tibial tubercle is medialized when the patella cannot be passively contained in the groove through a passive range of knee motion after appropriate lateral retinacular lengthening [141]. In the majority of cases, MPFL tears do not need to be addressed at the time of multiligament reconstruction surgery [22]. Respondents to an international survey considered age, generalized joint laxity, positivity/negativity of clinical tests of instability, contact sports participation, and associated MPFL lesions as possible indications for direct surgical management of the first episode of traumatic patellar dislocation [137]. Sex and affected side were not considered relevant in the surgical algorithms for managing the first episode of traumatic patellar dislocation [137].

Clinical Outcomes and Return to Sport

MPFL reconstruction is an effective and reliable treatment in the setting of patellofemoral instability [26]. Isolated MPFL reconstruction allowed return to pre-injury sports in 91% of patients, with 67% of patients returning to the same or higher level than pre-injury [16]. Surgical stabilization including MPFL reconstruction is an effective procedure for returning athletes to competitive sports with good clinical outcomes and a low rate of recurrence at 4-year follow-up [11]. Clinical scores after MPFL reconstruction provide only little insight into return to sport [7]. Patients who do not return to play following MPFL reconstruction exhibit poor psychological readiness, with the most common reason being fear of re-injury [20]. Patients undergoing MPFL reconstruction with or without correction of bony malalignment reported significant improvement over time with high return to sport rates and low recurrent dislocation rates [21]. Patients who underwent both isolated MPFL reconstruction and combined MPFL reconstruction with tibial tubercle osteotomy had excellent return to sport rates, with isolated MPFL reconstruction patients reporting significantly higher rates of return to the same or higher level of sport [50]. Adolescent patients with MPFL reconstruction exhibited altered squat and jumping mechanics during the return to sport phase [54]. Combined MPFL and MPTL reconstruction in young adults results in significant improvement in subjective knee function with minimal risks, although preinjury activity levels are not consistently restored [4]. Revision surgery for MPFL reconstruction failure, including the correction of major anatomic risk factors, yielded a significant improvement in patient-reported quality-of-life outcome measures [19].

Complications and Failure Rates

Complications following primary MPFL reconstruction ranged from 0% to 32.3% of knees, primarily consisting of residual anterior knee pain [18]. The 7.4% redislocation rate in a cohort with multiple severe anatomical risk factors is comparable to rates reported in the literature and is acceptable given the high-risk profile [2]. MPFL reconstruction in isolation or combined with MPTL reconstruction in skeletally immature patients with additional uncorrected anatomical patellofemoral abnormalities leads to acceptable clinical outcomes within a minimum of 5 years follow-up, although has a high failure rate of 24.1% [56]. In patients under 18 years old with refractory patella instability, both MPFL reconstruction and primary repair demonstrated similar improvements in subjective outcome [25]. MPFL reconstruction in young patients can be considered an effective and safe treatment leading to clinical improvement in terms of recurrence of dislocation [17]. There are clinically relevant improvements in knee function and pain after MPFL reconstruction in paediatric patients [61]. A pooled total risk of recurrent instability after isolated MPFL reconstruction is 1.2% with a reoperation risk of 3.1% [121].

Influence of Anatomical Risk Factors

No anatomic risk factor independently influenced the clinical results after MPFL reconstruction significantly [23]. Midterm outcomes for patients who underwent isolated MPFL reconstruction were favorable and were maintained at 5 years regardless of tibial tubercle–trochlear groove distance and patellar height [9]. MPFL reconstruction without distal realignment may be among the useful procedures, even in cases with severe predisposing factors [14]. At least some degree of patella alta, trochlear dysplasia, and lateralization of the tibial tuberosity relative to the trochlear groove can be tolerated in isolated MPFL reconstruction, although absolute threshold values have not been established [116]. Individual anatomical parameters will not provide an absolute guide for isolated MPFL reconstruction; a combination of factors needs to be considered [116]. The highest Insall–Salvati index in the isolated group was 1.5 and 1.6 in the combined group, and this index alone did not appear to have a significant influence on outcome [116].

Investigations

Plain radiography: Radiographs serve as appropriate initial imaging studies for most knee conditions, allowing assessment of traumatic injury, arthritis, patellofemoral alignment, osteochondral injury, bone neoplasm, and surgical implants [103]. Patellofemoral views specifically evaluate patellofemoral alignment (tilt/subluxation), patellar and trochlear morphology, osteochondral injury, and patellofemoral arthritis [103]. While radiographs may underestimate isolated chondral lesions, they can demonstrate joint space narrowing, osteophytes, sclerosis, and cysts [107]. The ability to detect subtle narrowing or an isolated chondral defect on the flexion surface may be improved with a semiflexed PA view [107]. Measurement of the femoral tunnel position on postoperative lateral radiographs is not an accurate or reliable method for evaluating tunnel position after MPFL reconstruction due to exposure, contrast, and malrotation from a true-lateral image [213].

MRI: MRI accurately diagnoses femoral MPFL injury in first-time patellar dislocations, whereas arthroscopy does not [34]. If a primary MPFL repair is planned, the determination of the repair site should be based on preoperative MRI [34]. MRI may identify the degree of articular cartilage injury (chondrosis, full-thickness cartilage loss), the presence of associated bone marrow edema, and the location (medial condyle, lateral condyle, trochlea, patella; anterior, posterior) [103]. MRI can also be used to evaluate articular cartilage morphology [107].

Other Considerations: Diagnostic arthroscopy performed at the time of MPFL reconstruction may reveal findings that were not previously appreciated on MRI [45]. Both open and radiographic localization of the femoral graft position in MPFL reconstruction offer similar outcomes and rates of complications [3]. Substantial cartilage damage was present in 56% of patients who underwent isolated MPFL reconstruction for recurrent patellar instability, with medial patellar lesions being the most common [62]. Articular cartilage injuries are associated with other intra-articular pathology such as meniscal tears, ACL tears, and patellar dislocations [107]. Patients ≥30 years at the time of MPFL reconstruction demonstrate similar subsequent dislocation risk but poorer KOOS pain subscale and Marx activity values than patients <30 years at the time of MPFL reconstruction [80].

Treatment

Non-Operative

Nonoperative management is associated with an increased risk of recurrent dislocations and higher average costs compared to MPFL reconstruction [212]. For acute first-time patellar dislocations, non-surgical treatment achieves better clinical outcomes regarding lower patellar instability rates and subjective function specifically for overlap-region MPFL injuries, making it the treatment of choice in that specific context [178].

Operative

Indications: MPFL reconstruction is an accepted method to restore static medial stabilization for patients with recurrent patellar instability who have failed nonoperative management [66]. It remains a durable option for both first-time and recurrent patellar instability, presenting with relatively low rates of recurrent instability [42]. While MPFL reconstruction decreases recurrent dislocation compared with MPFL repair or nonoperative treatment, it carries a higher possibility of complications [73]. Joint hypermobility is not a contraindication to surgery, although caution is recommended when managing patient expectations in hypermobile individuals [185].

Surgical Approach / Technique: The most typical grafts used are hamstrings, allografts, and, more recently, synthetic grafts [79]. There are no significant differences in return to activity, pain score changes, or failure incidences between patients undergoing MPFLR with allograft versus autograft [220]. Regarding fixation, soft-tissue graft fixation at the femoral condyles yields subjective clinical outcomes, patellar stability, and pain levels similar to bone fixation [12]. Patellar bone sockets show a larger range of complication rates than cortical fixation techniques, though overall complications remain uncommon [208]. Biomechanical studies indicate that MPFL reconstruction with 3 transosseous sutures provides a higher load to failure than suture anchor fixation [194]. Both fixation techniques provide sufficient primary stability superior to previously reported native MPFL tensile strengths [196]. Three reconstruction methods were stronger than the native MPFL, with the strongest being interference screw patella suspensory cortical fixation femur [191]. Mean load-to-failure values for both reconstruction techniques exceeded literature-reported values for the native MPFL [68, 27]. Fixation of the MPFL graft at 60° of flexion most closely restores patellofemoral contact pressure compared with the intact knee [67]. There is no consensus on the use of anchors, the order of graft fixation, indications for trochleoplasty, postoperative immobilization, or early return to sport in paediatric patients [207].

Adjuncts: There is no indication for systematic lateral retinacular release in association with MPFL reconstruction for recurrent patellar dislocation [172]. MPFL reconstruction combined with lateral retinacular release failed to demonstrate significantly different functional outcome scores or failure rates compared with isolated MPFL reconstruction at minimum 1-year follow-up [5]. The addition of an appropriately indicated tibial tubercle osteotomy (TTO) appears safe and effective [39]. Matched patients undergoing MPFLR with TTO compared with isolated MPFLR demonstrate no statistically significant difference in patient-reported outcomes, pain levels, or satisfaction postoperatively [253]. There was insufficient evidence to conclude that adding MPFL reconstruction to TTO results in fewer redislocations or reoperations [204]. However, patients who underwent MPFL reconstruction in addition to TTO had a comparatively significant improved patella congruence on quantitative CT scan [41]. Concomitant cartilage restoration does not demonstrate consistent additional clinical benefit in medial patellofemoral ligament reconstruction [40]. IMGG with plates or screws in the setting of combined MPFL reconstruction improves genu valgum [187].

Revision: Revision surgery for MPFLR failure, including the correction of major anatomic risk factors, yielded a significant improvement in patient-reported quality-of-life outcome measures [19]. MPFL reconstruction, alone or in combination, is an effective treatment for recurrent patellar dislocations after a failed previous surgery, leading to significant increases in stability and functionality as well as a reduction in pain [226].

Other Considerations: The lower incidence of pain complaints in the MPFL reconstruction group encourages its use as the first choice technique [69]. PPR has demonstrated durable results with a lower overall complication rate, much of which is caused by MPFL reconstruction having unique complications due to fixation methods [203]. Satisfactory midterm clinical results and a low incidence of patellofemoral arthritis have been observed after MPFL reconstruction for patellar instability in patients with low-grade trochlear dysplasia [252]. In paediatric patients, there are clinically relevant improvements in knee function and pain after MPFL reconstruction [61]. MPFL/MQTFL reconstruction in skeletally immature patients with first-time patellofemoral dislocation demonstrated lower failure rates and improved functional outcomes at a minimum 2-year follow-up compared with nonoperative management [15]. Pediatric opioid prescribing practices after MPFLR have become more conservative, reflecting ongoing efforts to reduce opioid use while maintaining effective pain management [214]. For acute first-time patellar dislocations, early MPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferiority with respect to range of motion deficits compared to nonoperative treatment [199, 209]. If a primary MPFL repair is planned, determination of the site of repair should be based on the preoperative MRI [34].

Complications

Overall Complication Rates: In a cohort of 179 knees in young patients, 29 knees (16.2%) had an identifiable complication, comprising 34 major and 4 minor events [142]. In studies of MPFL reconstruction combined with bony procedures, functional failures ranged from 0% to 8.8%, minor complications from 0% to 40%, and reoperations from 4.5% to 17.65% [114]. A meta-analysis of 17 case series confirms that MPFL reconstruction for recurrent patellar dislocation results in a low redislocation rate and acceptable complication rate [274]. Despite a rapid rise in procedures from 2005 to 2013, the overall risk of recurrent dislocation after MPFL reconstruction remained high at 21% [81, 82]. However, the use of either allograft or autograft tissue results in a very low (<3%) risk of repeat dislocation [225]. Recurrent patellofemoral instability rates after MPFL reconstruction are in the range of instability rates after other soft tissue realignment techniques [271], with published studies reporting a recurrence rate of patellofemoral dislocation of 0% to 4%, though follow-up in these studies was short [211]. MPFL reconstruction approaches seem to offer superior or at least equal functional outcomes compared with older realignment and stabilization techniques with less perioperative morbidity and fewer long-term complications [224].

Instability: Recurrent instability remains a primary concern. Multiple anatomic risk factors and femoral tunnel malposition are commonly observed in patients with reinstability after primary MPFL reconstruction [265]. In a series of 620 MPFL reconstructions, about one-third of the complications were recurrent apprehensions [238]. The surgical procedure of operative repair (reattachment) of the MPFL to its femoral attachment had a significantly high rate of failure in patients with chronic (repeat) lateral patellar dislocations [264]. MPFL primary repair had a significantly increased rate of complication requiring re-operation, particularly recurrent patella instability requiring revision to MPFL reconstruction, in patients under 18 years old [83]. Females experienced higher rates of recurrent dislocation and recorded worse patient-reported outcome measures following MPFL reconstruction [276]. Isolated MPFL reconstruction can achieve good short-term clinical results in a challenging cohort with multiple severe anatomical risk factors, with a 7.4% redislocation rate [2].

Stiffness / Arthrofibrosis: Flexion contracture due to excessive graft tension is the most common complication of MPFL reconstruction [211]. Joint stiffness was the most common complication reported in a study of 320 knees, with an overall complication rate of 12.5% [238]. Major complications described in a series of 620 MPFL reconstructions included revision operations due to loss of flexion [238].

Patellar / Extensor-mechanism: Patellar fractures occurred in 10 (1.1%) of 930 patients in a study reporting an overall complication rate of 8.8% [238]. Major complications in a series of 620 MPFL reconstructions included revision operations due to patellar fractures [238]. Malpositioning of the femoral tunnel (38.2%), unaddressed trochlear dysplasia (18.4%), and patellar fractures (11.8%) are the most common causes of revision operation after MPFL reconstruction [238].

Graft and Fixation-Related Outcomes: Patients treated with MPFL reconstruction experienced similar complication profiles irrespective of graft type (autograft vs. allograft) [74, 75]. MPFL reconstruction with soft-tissue graft fixation at the femoral condyles resulted in findings for subjective clinical outcome, patellar stability, and pain level similar to those associated with MPFL reconstruction with bone fixation [12]. Patients with suture anchor fixation at the patella site reported significantly less-positive apprehension tests, revision surgeries, and anterior knee pain compared with bone tunnel and interference screw fixation [238]. There was a low rate of recurrent instability following MPFL reconstruction with allograft, with excellent patient reported outcomes, and a low complication rate [259]. MPFL reconstruction using pedicled quadriceps tendon autograft yields less donor-site morbidity compared with gracilis tendon autograft [238]. Significantly more patients treated with gracilis tendon autograft reported a sensory loss in the lower leg compared with those treated with quadriceps tendon autograft [238].

Concomitant Procedures and Revision Surgery: The addition of tibial tubercle osteotomy (TTO) to MPFL reconstruction increased the overall complication rate but had a lower 2-year rate of recurrent instability requiring revision than MPFL reconstruction alone [256]. The addition of TTO to MPFL reconstruction reduced revision surgical rates for instability from 11.1% to 6.6%, though this difference was not statistically significant [275]. The MPFL reconstruction cohort exhibited higher rates of revision surgery at 2 years compared with the MPFL reconstruction-TTO cohort [269]. Although revision MPFL reconstruction establishes acceptable patellar stability, the subjective outcomes after revision MPFL reconstruction do not improve significantly and are poorer than after primary MPFL reconstruction [273]. Tailored revision surgery for failed MPFL reconstruction significantly improves the patient-reported disease-specific quality of life when performed for recurrent instability [258]. Primary MPFL reconstruction with concomitant TTO versus revision MPFL reconstruction with concomitant TTO have comparable objective and subjective outcomes at short term follow-up [260, 261].

Recovery

Light activity (weeks): The provided evidence does not specify a typical week range for light activities such as desk work, driving, or light ADLs.

Full activity (months): The provided evidence does not specify a typical month range for full activity, including manual work, sport, or full ROM/strength return.

Complete recovery / outcome plateau (months): The provided evidence does not specify a month range for when pain, strength, and final functional outcomes stabilise.

Rehabilitation protocol: There is substantial variability in content and timing across rehabilitation protocols following MPFL reconstruction [139]. An accelerated rehabilitation program following isolated MPFL reconstruction is safe, effective, and yields a low risk of repeat dislocation [164]. Specifically, the risk of repeat dislocation with an accelerated rehabilitation program is less than 2% [179], which is comparable to the risk reported in existing literature [179]. The technique of anatomical MPFL reconstruction using a free gracilis autograft enables an early functional rehabilitation [32]. Successful execution of MPFL reconstruction with lateral retinacular lengthening allows patients to undergo early aggressive rehabilitation and return to activities [181]. Clinicians should ensure that athletes are fully rehabilitated before returning to sport after MPFL reconstruction by emphasizing functional multijoint exercises [166].

Functional milestones: Young patients who return to sports at their pre-injury levels before 9 months after MPFL reconstruction have a higher incidence of postoperative anterior knee pain compared to those who delay their return [154]. These early returners also have poorer functional outcomes compared to those who delay their return [154]. Patients with MPFL reconstruction experience worse persistent patient-reported and functional deficits during the terminal phases of rehabilitation as compared to individuals with ACL reconstruction [146]. The vastus medialis obliquus demonstrated a significant difference in activity between limbs at return-to-sport clearance following MPFL reconstruction [165]. This differential VMO activity suggests that there may be muscle weakness following surgery and ongoing through physical therapy [165].

Other Considerations: Isolated MPFL reconstruction allowed return to pre-injury sports in 91% of patients [16]. Of those returning to sport, 67% returned to the same or higher level than pre-injury [16]. Patients undergoing isolated MPFL reconstruction reported significantly higher rates of return to the same or higher level of sport compared to those undergoing combined MPFL reconstruction and tibial tubercle osteotomy [50]. Conversely, 42% of patients return to sport at lower activity levels compared to pre-injury level following MPFL reconstruction [231]. Lower activity levels at return to sport are especially observed in older patients and patients who undergo concomitant tibial tubercle osteotomy [231]. Patients who underwent MPFL reconstruction with anteromedializing tibial tubercle osteotomy demonstrated similar rates of return to sport compared to an isolated MPFL reconstruction matched comparison group [205]. However, patients undergoing isolated MPFL reconstruction returned to sport more quickly than those undergoing combined MPFL reconstruction and tibial tubercle osteotomy [205]. In populations with severe anatomical risk factors, 93% of patients returned to sports following isolated MPFL reconstruction [2]. Patients who underwent bilateral MPFL reconstruction returned to sports at a similar rate and level compared to a unilateral comparison group [155]. These bilateral patients also demonstrated equivalent satisfaction and functional outcome scores compared to a matched unilateral comparison group [177]. Among US military servicemembers, only 42.4% undergoing primary MPFL reconstruction were able to return to unrestricted impact activity after surgery [148]. Another cohort reported that only 50% of military servicemembers undergoing primary MPFL reconstruction were able to return to unrestricted impact activity [158]. Patients that do not return to play following MPFL reconstruction exhibit poor psychological readiness [20]. The most common reason for poor psychological readiness in these patients is fear of re-injury [20]. Individual psychological characteristics and personality structures have a significant influence on the functional outcome and the psychological readiness to return to sport after MPFL reconstruction [215]. Patients who underwent MPFL reconstruction with anteromedializing tibial tubercle osteotomy demonstrated similar psychological readiness compared to an isolated MPFL reconstruction matched comparison group [205]. Isolated MPFL reconstruction using a high-strength suture tape construct resulted in durable patellar stability and high patient-reported success at a minimum 5-year follow-up [267]. The primary indicators of patient satisfaction at one year following MPFL reconstruction are young age, normal patellar cartilage, and good physical function at the time of surgery [162].

Key Evidence

• [L4] Further investigation is needed to determine safe and effective guidelines for return to play after MPFL reconstruction and repair. [1] (10.1177/0363546517713663)
• [L4] This study demonstrated that isolated MPFL reconstruction can achieve good short-term clinical results in a challenging cohort with multiple severe anatomical risk factors. 93% of patients returned to sports, and the 7.4% redislocation rate is comparable to rates reported in literatures and is acceptable given the high-risk profile. [2] (10.1186/s12891-026-09910-x)
• [L1] Both open and radiographic localization of the femoral graft position in MPFL reconstruction offer similar outcomes and rates of complications. [3] (10.1177/23259671221148482)
• [L4] Combined MPFL and MPTL reconstruction in young adults results in significant improvement in subjective knee function with minimal risks, although preinjury activity levels are not consistently restored. [4] (10.1007/s00167-018-5145-6)
• [L3] MPFL reconstruction surgery combined with LRR failed to demonstrate significantly different functional outcome scores and failure rates compared with isolated MPFL reconstruction at minimum 1-year follow up. [5] (10.1016/j.asmr.2024.100890)
• [L3] However, MPFL repair and reconstruction provide similar clinical results, return to play rates and reoperation rates. [6] (10.1177/2325967121s00618)
• [L4] Clinical scores after MPFL reconstruction provide only little insight into return to sport. [7] (10.1055/s-0039-1696647)
• [L4] Outcomes and risk profiles are similar to those of isolated MPFL reconstruction. [8] (10.1016/j.arthro.2015.11.039)
• [L4] Midterm outcomes for patients who underwent isolated MPFL reconstruction were favorable and were maintained at 5 years. [9] (10.1177/03635465241260039)
• [L3] MPFL reconstruction may provide improved midterm clinical outcomes and a decreased recurrence rate compared with MPFL repair. [10] (10.1016/j.arthro.2019.05.007)
• [L4] Surgical stabilization including MPFL reconstruction is an effective procedure for returning athletes to competitive sports with good clinical outcomes and a low rate of recurrence at 4-year follow-up. [11] (10.1007/s00167-016-4409-2)
• [L1] MPFL-R with soft-tissue graft fixation at the femoral condyles resulted in findings for subjective clinical outcome, patellar stability, and pain level similar to those associated with MPFL-R with bone fixation. [12] (10.1016/j.arthro.2018.11.051)
• [L2] [13] (10.1177/0363546510397174)
• [L4] MPFL reconstruction without distal realignment may be among the useful procedures, even in cases with severe predisposing factors. [14] (10.1016/j.arthro.2006.07.034)
• [L3] MPFL/MQTFL reconstruction in skeletally immature patients with first-time patellofemoral dislocation demonstrated lower failure rates and improved functional outcomes at a minimum 2-year follow-up compared with nonoperative management. [15] (10.1016/j.arthro.2025.01.021)
• [L4] Isolated MPFL reconstruction allowed return to pre-injury sports in 91% of patients, with 67% of patients returning to the same or higher level than pre-injury. [16] (10.1007/s00167-021-06815-1)
• [L1] MPFL reconstruction in young patients can be considered an effective and safe treatment leading to clinical improvement in terms of recurrence of dislocation. [17] (10.3390/children8060434)
• [L1] Complications following primary MPFL reconstruction ranged from 0% to 32.3% of knees, primarily consisting of residual anterior knee pain. [18] (10.1016/j.arthro.2023.01.098)
• [L3] Revision surgery for MPFLR failure, including the correction of major anatomic risk factors, yielded a significant improvement in patient-reported quality-of-life outcome measures. [19] (10.1177/0363546520966354)
• [L4] Following MPFL reconstruction, patients that do not return to play exhibit poor psychological readiness with the most common reason being fear of re-injury. [20] (10.1007/s00167-021-06440-y)
• [L3] Patients undergoing MPFL reconstruction with or without correction of bony malalignment reported significant improvement over time with high return to sport rates and low recurrent dislocation rates. [21] (10.1177/2325967120s00128)
• [L3] In the majority of cases, MPFL tears do not need to be addressed at the time of multiligament reconstruction surgery. [22] (10.1177/0363546515576902)
• [L4] No anatomic risk factor independently influenced the clinical results after MPFL reconstruction significantly. [23] (10.1055/s-0039-1688917)
• [L3] Both allograft and autograft remain viable options for MPFL reconstruction with no significant differences in failure rates, patient-reported outcomes, pain, or complications. [24] (10.1177/23259671241256983)
• [L3] In patients under 18 years old with refractory patella instability, both MPFL reconstruction and primary repair demonstrated similar improvements in subjective outcome. [25] (10.1016/j.arthro.2020.12.042)
• [L1] MPFL reconstruction is an effective and reliable treatment in the setting of patellofemoral instability. [26] (10.1177/0363546521990004)
• [L5] Both reconstruction techniques provide greater ultimate failure loads than those reported for the native MPFL in previous studies. [27] (10.1177/2325967119s00109)
• [L3] Both MPFL reconstruction and tibial tubercle transfer procedures are viable procedures allowing quick recovery, low rates of instability, and minimal risk of complication. [28] (10.1016/j.arthro.2007.03.074)
• [L4] MPFL reconstruction using allograft tissue may be performed safely in the pediatric and adolescent population with good outcomes at mid-term follow-up with few complications and low rate of recurrent instability. [29] (10.1177/2325967121s00103)
• [L3] Both allograft and autograft remain viable options in MPFL reconstruction. [30] (10.1177/2325967121s00617)
• [L5] The understanding of the complexity of the medial patellar stabilizers continues to evolve. [31] (10.1007/s00167-018-5266-y)
• [L4] The technique described offers the opportunity of an anatomical MPFL reconstruction, enabling the reconstructed ligament to have an isometric function and being effective through a greater range of motion, enabling an early functional rehabilitation, and avoiding an increase of patellofemoral pressure in higher degrees of knee flexion. [32] (10.1007/s00402-007-0300-4)
• [L4] These early and medium-term results are comparable with those of other MPFL reconstruction techniques reported in the literature. [33] (10.1177/0363546511420079)
• [L3] Thus, if a primary MPFL repair is planned, determination of the site of repair should be based on the preoperative MRI. [34] (10.1007/s00167-011-1775-7)
• [L5] [35] (10.1002/atn2.70002)
• [L3] In a cohort of patients undergoing MPFL reconstruction, the addition of an appropriately indicated TTO appears to be both safe and effective. [39] (10.1177/2325967119s00307)
• [L4] [40] (10.1002/ksa.70517)
• [L1] Patients who underwent an MPFL reconstruction in addition to a TTT had a comparatively significant improved patella congruence on quantitative CT Scan. [41] (10.1177/2325967116s00019)
• [L3] MPFL reconstruction remains as a durable surgical treatment option for patients presenting with either first-time or recurrent patellar instability with relatively low rates of recurrent instability. [42] (10.1177/2325967125s00213)
• [L3] Diagnostic arthroscopy with MPFL reconstruction may result in findings not previously appreciated on MRI. [45] (10.1177/2325967120945654)
• [L3] A preoperative jumping sign was present in almost 70% of patients with MPFL graft failure. [46] (10.1177/23259671251399799)
• [L5] Our technique is simple, anatomic, and cost-effective in incorporating the advantages of various techniques to provide a strong MPFL reconstruction with minimal complications. [47] (10.1016/j.eats.2024.103318)
• [L3] Patients who underwent both isolated MPFL-R and MPFL-TTO had excellent return to sport rates, with isolated MPFL-R patients reporting significantly higher rates of return to the same or higher level of sport. [50] (10.1016/j.jisako.2025.100717)
• [L4] [53] (10.1177/03635465231164400)
• [L3] Adolescent patients with MPFL reconstruction exhibited altered squat and jumping mechanics during the return to sport phase. [54] (10.1002/ksa.70442)
• [L2] Substantial cartilage injuries are present in 56% of patients who undergo primary isolated MPFL reconstruction, with medial patellar lesions being the most common. [55] (10.1016/j.jisako.2023.03.307)
• [L3] MPFL reconstruction in isolation or combined with MPTL reconstruction in skeletally immature patients with additional uncorrected anatomical patellofemoral abnormalities leads to acceptable clinical outcomes within a minimum of 5 years follow-up, although has a high failure rate of 24.1%. [56] (10.1016/j.jisako.2023.02.003)
• [L4] MPFL reconstruction using allograft tissue may be performed safely in the pediatric and adolescent population with good outcomes at midterm follow-up, few complications, and a low rate of recurrent instability. [60] (10.1016/j.arthro.2021.05.005)
• [L3] There are clinical relevant improvements in knee function and pain after MPFL reconstruction in paediatric patients. [61] (10.1007/s00167-014-3439-x)
• [L3] Substantial cartilage damage was present in 56% of patients who underwent isolated MPFL reconstruction for recurrent patellar instability, with medial patellar lesions being the most common. [62] (10.1016/j.jisako.2025.100862)
• [L5] MPFL reconstruction is an accepted method to restore static medial stabilization for patients with recurrent patellar instability who have failed nonoperative management. [66] (10.1016/j.csm.2014.03.006)
• [L5] Fixation of the MPFL graft at 60° of flexion was able to most closely restore patellofemoral contact pressure compared with the intact knee. [67] (10.1016/j.arthro.2017.09.047)
• [L5] The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL. [68] (10.1177/2325967121989282)
• [L3] The lower incidence of pain complaints in the MPFL reconstruction group encourages its use as the first choice technique. [69] (10.1007/s00264-016-3119-1)
• [L1] Allografts may represent a feasible alternative to traditional autograft for MPFL reconstruction in selected patients with patellofemoral instability. [71] (10.1007/s00167-021-06569-w)
• [L3] MPFL reconstruction decreases recurrent dislocation compared with MPFL repair or nonoperative treatment, but it has a higher possibility of complications. [73] (10.1177/23259671211026624)
• [L2] Patients in this study treated with an MPFL-Reconstruction experienced similar complication profiles, irrespective of graft type. [74] (10.1177/2325967126s00373)
• [L2] Patients in this study treated with an MPFL reconstruction experienced similar complication profiles, irrespective of graft type. [75] (10.1177/2325967126s00257)
• [L3] MPFL reconstruction may serve as a more durable surgical treatment option with lower rates of recurrent instability and failure when compared with other patellofemoral stabilization procedures at up to 10 years after surgery. [76] (10.1177/03635465231182143)
• [L3] An increase in previously reported thresholds for when to add a bony procedure to an MPFL reconstruction can result in successful outcomes in some patients. [77] (10.1016/j.jisako.2023.03.301)
• [L4] Functional outcomes remain favorable as complication and failure profiles are improving with widespread implementation of MPFL reconstruction. [78] (10.1016/j.arthro.2014.12.029)
• [L5] [79] (10.1016/j.eats.2023.08.002)
• [L3] Patients ≥30 years at the time of MPFL reconstruction demonstrate similar subsequent dislocation risk but poorer KOOS pain subscale and Marx activity values than patients <30 years at the time of MPFL reconstruction. [80] (10.1177/23259671251324495)
• [L3] The overall risk of recurrent dislocation after MPFL-reconstruction remained high (21%) despite a rapid rise in MPFL-reconstructions from 2005 to 2013. [81] (10.1016/j.arthro.2017.08.058)
• [L3] The overall risk of recurrent dislocation after MPFL-reconstruction remained high (21%) despite a rapid rise in MPFL-reconstructions from 2005 to 2013. [82] (10.1016/j.arthro.2017.08.057)
• [L3] MPFL primary repair had significantly increased rate of complication requiring re-operation, particularly recurrent patella instability requiring revision to MPFL reconstruction. [83] (10.1177/2325967120s00189)
• [L4] [114] (10.1016/j.arthro.2016.01.013)
• [L3] [116] (10.1007/s00167-014-3132-0)
• [Paper] [121] (10.1016/j.eats.2017.03.005)
• [L5] Anatomically positioned reconstruction with 2-N tension fixed at 30 ° or 60 ° of knee flexion restored joint contact pressures and tracking. [123] (10.1177/0363546513509230)
• [L5] A pretension of 2 N was found to restore the knee joint closest to normal patellofemoral kinematics. [131] (10.1007/s00167-019-05668-z)
• [L3] [136] (10.1016/j.jisako.2023.03.304)
• [L4] [137] (10.1007/s00167-022-07273-z)
• [L3] Radiographic measures of tracking and alignment changed with knee motion and, in knees with instability symptoms, were most abnormal at lower flexion angles. [138] (10.1016/j.arthro.2014.04.036)
• [L4] There is substantial variability in content and timing across rehabilitation protocols following MPFL reconstruction. [139] (10.1177/2325967119855991)
• [Paper] [141] (10.1016/j.otsr.2009.09.002)
• [L4] [142] (10.1177/0363546513482085)
• [L3] Patients with MPFL reconstruction experience worse persistent patient-reported and functional deficits during the terminal phases of rehabilitation as compared to individuals with ACLR. [146] (10.1177/2325967120s00157)
• [L5] While patellar stability was similar to the intact state, kinematics were not optimal with the use of a smaller tubular graft compared to the native fan-shaped MPFL. [147] (10.1007/s00264-013-1938-x)
• [L4] Only 42.4% of US military servicemembers undergoing primary MPFL reconstruction were able to return to unrestricted impact activity after surgery. [148] (10.1177/23259671211013334)
• [L4] These findings highlight distinct anatomical phenotypes underlying dynamic patellar maltracking. [149] (10.1177/2325967126s00397)
• [L5] MPFL reconstruction restores patellar kinematics and contact mechanics to the intact state when the TT is in anatomic or 5-mm lateralized positions, but fails to do so when the TT is lateralized by 10 mm or 15 mm. [153] (10.1177/0363546515597906)
• [L3] Young patients who return to sports at their pre-injury levels before 9 months after MPFLR have a higher incidence of postoperative anterior knee pain and poorer functional outcomes compared to those who delay their return. [154] (10.1002/ksa.12411)
• [L3] Patients who underwent bilateral MPFLR returned to sports at a similar rate and level compared to a unilateral comparison group. [155] (10.1007/s00167-023-07462-4)
• [L3] Only 50% of military servicemembers undergoing primary MPFL reconstruction were able to return to unrestricted impact activity. [158] (10.1016/j.arthro.2019.11.028)
• [L5] Anatomic MPFL-C resulted in a favorable graft length change range (less than 2 mm) at 0 to 90 degrees of knee flexion, which was close to the isometric graft behavior. [160] (10.1016/j.arthro.2021.10.030)
• [L5] Anatomic reconstruction of the MPFL may not fully restore patellofemoral pressure distributions compared to the native knee. [161] (10.1007/s00167-016-4005-5)
• [L3] The primary indicators of patient satisfaction at one year following MPFL reconstruction are young age, normal patellar cartilage, and good physical function at the time of surgery. [162] (10.1177/2325967125s00261)
• [L4] An accelerated rehabilitation program following isolated MPFL reconstruction is safe, effective, and yields a low risk of repeat dislocation. [164] (10.1016/j.arthro.2018.10.040)
• [L4] The VMO demonstrated clear differences in activity at return-to-sport clearance following MPFL reconstruction with a significant difference between limbs, suggesting that there may be muscle weakness following surgery and ongoing through physical therapy. [165] (10.1177/2325967126s00090)
• [L3] Clinicians should ensure that athletes are fully rehabilitated before returning to sport after MPFL-R by emphasizing functional multijoint exercises. [166] (10.1177/2325967119825854)
• [L2] There is no indication to a systematic lateral retinacular release in association with MPFL reconstruction in the treatment of RPD. [172] (10.1007/s00167-018-5294-7)
• [L3] Patients who undergo MPFLR bilaterally are able to return to sports at a similar rate and to a similar level compared to a matched unilateral comparison group with equivalent satisfaction and functional outcome scores. [177] (10.1177/2325967123s00230)
• [L4] Non-surgical treatment achieves better clinical outcomes with respect to a lower patellar instability rate and better subjective function for the overlap-region injury of MPFL than for the non-overlap-region injury, and can be considered as treatment of choice for overlap-region injury of MPFL. [178] (10.1007/s00167-012-2020-8)
• [L4] An accelerated rehabilitation program following isolated MPFL reconstruction is safe, effective, and yields a low risk of repeat dislocation (<2%) that is comparable to the risk reported in the existing literature. [179] (10.1016/j.arthro.2018.10.039)
• [Paper] Successful execution of this procedure provides a strong MPFL construct that allows patients to undergo early aggressive rehabilitation and return to activities. [181] (10.1016/j.eats.2020.11.018)
• [L5] The patellar contact pressures after the dynamic MPFLr were like those of the native knee, whereas a static reconstruction resulted in greater pressures, potentially increasing the risk of patellofemoral osteoarthritis in the long term. [182] (10.3390/jcm8122093)
• [L4] The altered function of the patellar tendon in anterior cruciate ligament deficiency resulted in an altered patellar tracking and patellofemoral cartilage contact. [183] (10.1177/0363546508314404)
• [L3] Joint hypermobility is not a contraindication to MPFL reconstruction, although caution is recommended in managing the expectations of patients with hypermobility before consideration of surgery. [185] (10.1302/0301-620x.94b12.29562)
• [L4] IMGG with plates or screws in the setting of combined MPFL reconstruction improves genu valgum. [187] (10.1177/03635465231222934)
• [L5] In this study of simulated multidirectional motion, MPFL reconstruction did not sufficiently constrain the patella for some knees. [188] (10.1016/j.asmr.2023.100753)
• [L5] Three methods of reconstruction were stronger than the native MPFL, with the strongest being interference screw patella suspensory cortical fixation femur. [191] (10.1016/j.arthro.2014.04.035)
• [L5] MPFL grafts tend to carry minimal load beyond 30 of knee flexion during functional activities. [192] (10.1016/j.arthro.2019.11.026)
• [L4] Medial patellar instability following lateral retinacular release occurs during the unloading phase of gait when passive structures guide the patella, weakening the argument that muscle imbalance is the primary cause. [193] (10.1007/s001670050034)
• [L5] MPFL reconstruction with 3 transosseous sutures provided a higher load to failure than did the commonly used fixation method involving suture anchors. [194] (10.1177/23259671211041404)
• [L5] Both fixation techniques provided sufficient primary stability, superior to previously reported native MPFL tensile strengths. [196] (10.1007/s00167-022-07120-1)
• [L1] MPFL reconstruction at various angles of knee flexion and pretension levels showed no statistically significant differences in patellofemoral pressure compared to the native state. [198] (10.1016/j.arthro.2025.01.066)
• [L1] Early MPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferiority with respect to range of motion deficits compared to nonoperative treatment for the management of acute first-time patellar dislocations. [199] (10.1016/j.jisako.2023.03.313)
• [L4] [201] (10.1007/s00167-015-3613-9)
• [L4] The MPFC fibers demonstrated increased length changes in knees when a greater number of morphological risk factors for patellar instability were present, which worsened in the setting of nonanatomic configurations. [202] (10.1177/03635465231165296)
• [L3] PPR has demonstrated durable results, with a lower overall complication rate, much of which is caused by the MPFL reconstruction having unique complications due to fixation methods. [203] (10.2106/jbjs.rvw.24.00112)
• [L1] There was insufficient evidence to conclude that the addition of MPFL reconstruction to TTT results in fewer redislocations or reoperations. [204] (10.1177/0363546516666352)
• [L3] Patients who underwent MPFLR with anteromedializing TTO demonstrated similar rates of return to sport and psychological readiness compared to an isolated MPFLR matched comparison group, though iMPFLRs returned more quickly. [205] (10.1002/ksa.12051)
• [L5] There was no consensus on the use of anchors in MPFL reconstruction, the order of fixation of the graft, indications for trochleoplasty, postoperative immobilization, or early return to sport in paediatric patients. [207] (10.1302/0301-620x.105b12.bjj-2023-0110.r1)
• [L4] MPFL reconstruction techniques with patellar bone sockets showed a larger range of complication rates than cortical fixation techniques, although overall, complications remained uncommon. [208] (10.1016/j.arthro.2018.10.150)
• [L1] MPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferiority with respect to a range of motion deficits compared to nonoperative treatment for the management of acute first-time patellar dislocations. [209] (10.1007/s00167-022-07222-w)
• [L3] MPFL reconstruction with both semitendinosus and pedicled quadriceps tendon grafts yields successful results in well-selected patient groups. [210] (10.1002/ksa.12619)
• [L4] [211] (10.1016/j.otsr.2015.06.030)
• [L3] Patients undergoing nonoperative management experienced an increased risk of recurrent dislocations that resulted in higher average costs compared to the MPFLR group. [212] (10.1177/03635465251350394)
• [L2] Measurement of the femoral tunnel position on postoperative lateral radiographs is not an accurate or reliable method for evaluating tunnel position after MPFL reconstruction due to exposure, contrast, and malrotation of the radiograph from a true-lateral image. [213] (10.1007/s00167-019-05378-6)
• [L4] These results suggest that pediatric opioid prescribing practices after MPFLR have become more conservative, reflecting ongoing efforts to reduce opioid use in surgical care while maintaining effective pain management. [214] (10.1177/2325967126s00134)
• [L3] Individual psychological characteristics and personality structures have a significant influence on the functional outcome and the psychological readiness to return to sport after MPFL reconstruction. [215] (10.1016/j.jisako.2025.100735)
• [L4] [216] (10.1016/j.arthro.2018.02.049)
• [L4] [217] (10.1016/j.injury.2015.04.017)
• [L3] There were no significant differences in return to activity, pain score changes, or incidences of failure between patients undergoing MPFLR with allograft versus autograft. [220] (10.1177/2325967118774272)
• [L1] [224] (10.1177/0363546509353132)
• [L3] [225] (10.1016/j.arthro.2017.08.054)
• [L4] MPFL reconstruction, alone or in combination, seems to be an effective treatment for recurrent patellar dislocations after a failed previous surgery, leading to significant increases in stability and functionality as well as a reduction in pain. [226] (10.1177/0363546513498572)
• [L5] [229] (10.2106/jbjs.22.00756)
• [L4] Following MPFL reconstruction, 42% of patients return to sport at lower activity levels compared to pre-injury level, especially in older patients and patients who undergo concomitant tibial tubercle osteotomy. [231] (10.1016/j.arthro.2019.11.027)
• [L4] [235] (10.1016/j.arthro.2022.07.021)
• [L5] [236] (10.1016/j.arthro.2023.01.006)
• [L3] [238] (10.1016/j.arthro.2023.07.006)
• [L3] [252] (10.1002/ksa.70101)
• [L3] Matched patients undergoing MPFLR with TTO compared with isolated MPFLR demonstrate no statistically significant difference in patient-reported outcomes, levels of pain, and satisfaction postoperatively. [253] (10.1016/j.jisako.2021.10.004)
• [L3] Combined MPFLRTTO increased the overall complication rate but had a lower 2-year rate of recurrent instability requiring revision than MPFLR alone. [256] (10.1016/j.asmr.2024.100994)
• [L4] Tailored revision surgery for failed MPFL-R significantly improves the patient-reported disease-specific quality of life. [258] (10.1007/s00167-021-06734-1)
• [L4] There was a low rate of recurrent instability following MPFLR with allograft, with excellent patient reported outcomes, and a low complication rate. [259] (10.1177/2325967121s00296)
• [L3] This study demonstrates that primary MPFL+TTO versus revision MPFL+TTO have comparable objective and subjective outcomes at short term follow-up. [260] (10.1016/j.arthro.2023.01.081)
• [L3] This study demonstrates that primary MPFL+TTO versus revision MPFL+TTO have comparable objective and subjective outcomes at short term follow-up. [261] (10.1177/2325967121s00557)
• [L4] The surgical procedure of operative repair (reattachment) of the MPFL to its femoral attachment had a significantly high rate of failure in this patient group of chronic (repeat) lateral patellar dislocators. [264] (10.1007/s00167-011-1516-y)
• [L4] Multiple anatomic risk factors and femoral tunnel malposition are commonly observed in patients with reinstability after primary MPFL reconstruction. [265] (10.1177/2325967120926178)
• [L4] Isolated MPFL reconstruction using a high-strength suture tape construct resulted in durable patellar stability and high patient-reported success at a minimum 5-year follow-up. [267] (10.1002/ksa.70466)
• [L3] The MPFLR cohort exhibited higher rates of revision surgery at 2 years compared with the MPFLR-TTO cohort. [269] (10.1016/j.arthro.2023.02.006)
• [L1] This systematic review and meta-analysis found that recurrent patellofemoral instability rates after MPFL reconstruction techniques are in the range of instability rates after other soft tissue realignment techniques. [271] (10.1007/s00167-019-05656-3)
• [L3] Although revision MPFL-R establishes acceptable patellar stability, the subjective outcomes after revision MPFL-R do not improve significantly and are poorer than after primary MPFL-R. [273] (10.1007/s00167-017-4477-y)
• [L4] The meta-analysis of 17 case series shows that MPFL reconstruction for recurrent patellar dislocation results in a significant improvement in Kujala scores, a low redislocation rate, and acceptable complication rate. [274] (10.1177/2325967114544021)
• [L3] The addition of TTO to MPFLR reduced revision surgical rates for instability from 11.1 to 6.6% but this difference was not statistically significant. [275] (10.1177/2325967121s00793)
• [L2] Based on this systematic review, females experienced higher rates of recurrent dislocation and recorded worse PROMs following MPFL reconstruction. [276] (10.1016/j.arthro.2025.07.030)

See Also

• Anatomy
• Patellofemoral instability
• ACL reconstruction

References

[1] Return-to-Play Guidelines After Medial Patellofemoral Ligament Surgery for Recurrent Patellar Instability: A Systematic Review. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517713663

[2] Short-term clinical and radiographic outcomes after isolated medial patellofemoral ligament reconstruction for recurrent and first-time traumatic patellar dislocation with severe trochlear dysplasia, increased tibial tuberosity–trochlear groove distance, patella alta and lower extremity torsion deformities. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09910-x

[3] Stiffness and Instability After MPFL Reconstruction Using a Fluoroscopic Versus Open Technique to Localize the Femoral Attachment Site: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671221148482

[4] Combined reconstruction of the medial patellofemoral and medial patellotibial ligaments: outcomes and prognostic factors. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5145-6

[5] Adding Lateral Retinacular Release to Medial Patellofemoral Ligament Reconstruction Fails to Demonstrate Clinical Benefit Compared With Isolated Medial Patellofemoral Ligament Reconstruction. Arthroscopy, Sports Medicine, and Rehabilitation. 2024. DOI: 10.1016/j.asmr.2024.100890

[6] Paper 54: MPFL Repair has a Higher Failure Rate at Long-term Follow-up compared to MPFL Reconstruction for Recurrent Patellar Instability. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00618

[7] Timing for Safe Return to Sport after Medial Patellofemoral Ligament Reconstruction: The Role of a Functional Test Battery. The Journal of Knee Surgery. 2019. DOI: 10.1055/s-0039-1696647

[8] Medial Patellofemoral Ligament Reconstruction With Concomitant Tibial Tubercle Transfer: A Systematic Review of Outcomes and Complications. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2015.11.039

[9] Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Regardless of Tibial Tubercle–Trochlear Groove Distance and Patellar Height: Minimum 5-Year Outcomes. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241260039

[10] Primary Medial Patellofemoral Ligament Repair Versus Reconstruction: Rates and Risk Factors for Instability Recurrence in a Young, Active Patient Population. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.05.007

[11] Functional testing and return to sport following stabilization surgery for recurrent lateral patellar instability in competitive athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4409-2

[12] No Difference in Outcome Between Femoral Soft-Tissue and Screw Graft Fixation for Reconstruction of the Medial Patellofemoral Ligament: A Randomized Controlled Trial. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019. DOI: 10.1016/j.arthro.2018.11.051

[13] Zone of Injury of the Medial Patellofemoral Ligament After Acute Patellar Dislocation in Children and Adolescents. The American Journal of Sports Medicine. 2011. DOI: 10.1177/0363546510397174

[14] Bilateral Recurrent Patellar Dislocation in a Patient With Isolated Patella Aplasia‐Hypoplasia. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.07.034

[15] Combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament Reconstruction With Semitendinosus Allograft for Pediatric Patients With First‐Time Patella Dislocation Yields Low Failure Rates and Improved Functional Outcomes Compared With Nonoperative Treatment. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.01.021

[16] Medial patellofemoral ligament reconstruction for recurrent patellar dislocation allows a good rate to return to sport. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06815-1

[17] Complications and Recurrence of Patellar Instability after Medial Patellofemoral Ligament Reconstruction in Children and Adolescents: A Systematic Review. Children. 2021. DOI: 10.3390/children8060434

[18] Complication Rates After Medial Patellofemoral Ligament Reconstruction Range From 0% to 32% With 0% to 11% Recurrent Instability: A Systematic Review. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.01.098

[19] Patient-Reported Outcomes After Revision Surgery for Failed Medial Patellofemoral Ligament Reconstruction: A Matched-Pair Analysis Including Correction of Predisposing Factors. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520966354

[20] Patients unable to return to play following medial patellofemoral ligament reconstructions demonstrate poor psychological readiness. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06440-y

[21] Return To Sport Following Stabilization Surgery For Recurrent Patellar Instability In Patients Undergoing Isolated Mpfll Reconstruction Vs. Combined Mpfl Reconstruction And Tibial Tubercle Osteotomy. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00128

[22] Medial Patellofemoral Ligament Tears in the Setting of Multiligament Knee Injuries Rarely Cause Patellar Instability. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515576902

[23] Isolated Medial Patellofemoral Ligament Reconstruction Can Be an Effective Procedure in Patellofemoral Instability with Risk Factors. The Journal of Knee Surgery. 2019. DOI: 10.1055/s-0039-1688917

[24] Comparison of Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction With Allograft Versus Autograft: A Matched-Cohort Analysis. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/23259671241256983

[25] Patellofemoral Anatomy Research Excellence Award Paper: MPFL Repair vs. Reconstruction for Refractory Patella Instability in Patients Under 18 Years Old. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2020.12.042

[26] Return to Sport After Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2021. DOI: 10.1177/0363546521990004

[27] A BIOMECHANICAL COMPARISON OF SUTURE ANCHOR VS. INTERFERENCE SCREW TECHNIQUE FOR PATELLAR FIXATION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00109

[28] Comparison of Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Realignment for Treatment of Patellar Instability (SS‐60). Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.03.074

[29] CLINICAL OUTCOMES AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION UTILIZING ALLOGRAFT TISSUE IN PEDIATRIC AND ADOLESCENT PATIENTS: MINIMUM 2-YEAR FOLLOW-UP. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00103

[30] Paper 53: Comparing Graft Choice in Medial Patellofemoral Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00617

[31] Recognition of evolving medial patellofemoral anatomy provides insight for reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5266-y

[32] Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Archives of Orthopaedic and Trauma Surgery. 2007. DOI: 10.1007/s00402-007-0300-4

[33] Medial Patellofemoral Ligament Reconstruction With a Divergent Patellar Transverse 2-Tunnel Technique. The American Journal of Sports Medicine. 2011. DOI: 10.1177/0363546511420079

[34] MRI but not arthroscopy accurately diagnoses femoral MPFL injury in first‐time patellar dislocations. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1775-7

[35] Combined Reconstruction of the Medial Patellofemoral Ligament and the Medial Quadriceps Tendon–Femoral Ligament Using Rectus Femoris Tendon Autograft. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70002

[39] Medial Patellofemoral Ligament Reconstruction with and without Tibial Tubercle Osteotomy. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00307

[40] Concomitant cartilage restoration does not demonstrate consistent additional clinical benefit in medial patellofemoral ligament reconstruction: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70517

[41] MPFL Reconstruction with TTT Versus TTT Alone for Recurrent Patella Instability. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116s00019

[42] Poster 116: Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction after First-Time and Recurrent Patellar Instability - Recurrence, Return to Sport, and Osteochondral Injury: Data from the JUPITER Cohort. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00213

[45] Is Diagnostic Arthroscopy at the Time of Medial Patellofemoral Ligament Reconstruction Necessary?. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120945654

[46] Association Between Preoperative Patellar Jumping Sign and Graft Failure After Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251399799

[47] Anatomic Medial Patellofemoral Ligament Reconstruction Using “Double‐Socket” Technique. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103318

[50] Return to Sport Following Medial Patellofemoral Ligament Reconstruction Versus Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy for Recurrent Patellar Instability. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100717

[53] Medial Patellofemoral Ligament Reconstruction Using Allografts in Skeletally Immature Patients. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231164400

[54] Asymmetrical lower extremity biomechanics during squats and drop jumps in adolescents with MPFL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70442

[55] The Prevalence and Predictors of Articular Cartilage Damage at the Time of Medial Patellofemoral Ligament Reconstruction. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.307

[56] Medial patellofemoral ligament reconstruction in skeletally immature patients without correction of bony risk factors leads to acceptable outcomes but higher failure rates. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.02.003

[60] Allograft Medial Patellofemoral Ligament Reconstruction in Adolescent Patients Results in a Low Recurrence Rate of Patellar Dislocation or Subluxation at Midterm Follow‐Up. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.05.005

[61] Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3439-x

[62] Articular cartilage damage is frequently noted at the time of medial patellofemoral ligament reconstruction and is associated with age and patellofemoral anatomy. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100862

[66] MPFL Reconstruction. Clinics in Sports Medicine. 2014. DOI: 10.1016/j.csm.2014.03.006

[67] Medial Patellofemoral Ligament Reconstruction: Impact of Knee Flexion Angle During Graft Fixation on Dynamic Patellofemoral Contact Pressure—A Biomechanical Study. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2017.09.047

[68] Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121989282

[69] Preliminary results of two surgical techniques in the treatment of recurrent patellar dislocation. International Orthopaedics. 2016. DOI: 10.1007/s00264-016-3119-1

[71] Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06569-w

[73] Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211026624

[74] Poster 62. Autograft versus Allograft---Medial Patellofemoral Ligament Reconstruction for Patellofemoral Instability: Data from the JUPITER Cohort. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00373

[75] Autograft versus Allograft Medial Patellofemoral Ligament Reconstruction for Patellofemoral Instability in Adolescents: Data from the Jupiter Cohort. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00257

[76] Surgical Stabilization for Recurrent Patellar Instability in Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 6-Year Mean Follow-up. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231182143

[77] The Impact of Tibial Tubercle-Trochlear Groove Distance and Patellar Height on the Outcome of Isolated MPFL Reconstruction: An ISAKOS-Sponsored Multi-Center Study. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.301

[78] Widespread Implementation of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Maintains Functional Outcomes at Midterm to Long‐Term Follow‐up While Decreasing Complication Rates: A Systematic Review. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2014.12.029

[79] Medial Patellofemoral Ligament Reconstruction Using Gracilis Tendon Graft and “All Suture” Knotless Anchors for Patellar Fixation. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.08.002

[80] Does Patient Age Matter for Medial Patellofemoral Ligament Reconstruction? Patients ≥30 Years of Age Compared With Younger Patients. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251324495

[81] Paper #69: Biomechanical Effects of Mptl Reconstruction – A Comparison With Two Techniques For Mpfl Reconstruction. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.058

[82] Paper #68: High Failure Rate After Medial Patellofemoral Ligament Reconstructions. A Nationwide Epidemiological Study Investigating 2.572 Medial Patellofemoral Ligament Reconstructions And 24.154 Primary Dislocations. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.057

[83] Comparison of MPFL Repair Versus MPFL Reconstruction for Refractory Patella Instability in Patients Under 18 Years Old. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00189

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[114] Medial Patellofemoral Ligament Reconstruction Combined With Bony Procedures for Patellar Instability: Current Indications, Outcomes, and Complications. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.01.013

[116] Medial patellofemoral ligament reconstruction as an isolated or combined procedure for recurrent patellar instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3132-0

[121] Medial Patellofemoral Ligament Reconstruction in a Revision Setting: Anchor and Interference Screw Fixation. Arthroscopy Techniques. 2017. DOI: 10.1016/j.eats.2017.03.005

[123] The Effect of Femoral Tunnel Position and Graft Tension on Patellar Contact Mechanics and Kinematics After Medial Patellofemoral Ligament Reconstruction. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513509230

[131] Repair of the medial patellofemoral ligament with suture tape augmentation leads to similar primary contact pressures and joint kinematics like reconstruction with a tendon graft: a biomechanical comparison. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05668-z

[136] Body Mass Index Does Not Affect Outcomes Following Medial Patellofemoral Ligament Reconstruction: A Retrospective Analysis of 161 Knees. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.304

[137] Management of the first episode of traumatic patellar dislocation: an international survey. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-07273-z

[138] Tibial Tuberosity‐Trochlear Groove Distance and Patellar Tracking in Symptomatic and Asymptomatic knees in Patients with Unilateral Patellofemoral Instability. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.04.036

[139] Quality and Variability of Online Available Physical Therapy Protocols From Academic Orthopaedic Surgery Programs for Medial Patellofemoral Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119855991

[141] MPFL reconstruction for PF instability. The soft (tissue) approach. Orthopaedics & Traumatology: Surgery & Research. 2009. DOI: 10.1016/j.otsr.2009.09.002

[142] Complications of Medial Patellofemoral Ligament Reconstruction in Young Patients. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513482085

[146] COMPARISON OF CLINICAL OUTCOMES BETWEEN INDIVIDUALS WITH MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION AND ANTERIOR CRUCIATE LIGAMENT. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00157

[147] Are the tubular grafts in the femoral tunnel in an anatomical or isometric position in the reconstruction of medial patellofemoral ligament?. International Orthopaedics. 2013. DOI: 10.1007/s00264-013-1938-x

[148] Primary Medial Patellofemoral Ligament Reconstruction in Military Servicemembers: Can We Reliably Restore Preinjury Function and Stability?. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211013334

[149] Poster 91. Multidomain Statistical Shape Modeling to assess Anatomic Variations Underlying the J-sign in Patellofemoral Instability Patients. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00397

[153] The Ability of Medial Patellofemoral Ligament Reconstruction to Correct Patellar Kinematics and Contact Mechanics in the Presence of a Lateralized Tibial Tubercle. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515597906

[154] Returning to pre‐injury level of sports before 9 months after medial patellofemoral ligament reconstruction increases the incidence of anterior knee pain in young patients. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12411

[155] Patients who undergo bilateral medial patellofemoral ligament reconstruction return to sport at a similar rate as those that undergo unilateral reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2023. DOI: 10.1007/s00167-023-07462-4

[158] Medial Patellofemoral Ligament Reconstruction in Military Servicemembers: Can We Reliably Restore Pre‐injury Function and Patellar Stability?. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.028

[160] Medial Patellofemoral Ligament Reconstruction Using Adductor-Transfer and Adductor-Sling at Nonanatomic Femoral Attachment Sites Leads to Unfavorable Graft-Length Change Patterns: A Descriptive Biomechanical Study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022. DOI: 10.1016/j.arthro.2021.10.030

[161] Biomechanical evaluation of MPFL reconstructions: differences in dynamic contact pressure between gracilis and fascia lata graft. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4005-5

[162] Poster 168: Age, Physical Function and Cartilage Status at the Time of Surgery are the Primary Factors Influencing Patient Satisfaction at One Year Following MPFL Reconstruction. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00261

[164] Clinical Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction in Patients with Patella Alta and Excessive Rotational Malalignment. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.10.040

[165] Differential Quadriceps Muscle Dysfunction Preoperatively and at Return to Sport Following Medial Patellofemoral Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00090

[166] Biomechanical and Functional Outcomes After Medial Patellofemoral Ligament Reconstruction: A Pilot Study. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119825854

[172] Lateral retinacular release is not recommended in association to MPFL reconstruction in recurrent patellar dislocation. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5294-7

[177] Poster 251: Patients who Undergo Bilateral Medial Patellofemoral Ligament Reconstruction Return to Sport at a Similar Rate to Unilaterals: A Matched Cohort Study. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00230

[178] Non‐surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2020-8

[179] Accelerated Rehabilitation Program Following Medial Patellofemoral Ligament Reconstruction Does Not Increase Risk of Recurrent Instability. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.10.039

[181] Medial Patellofemoral Ligament Reconstruction and Lateral Retinacular Lengthening from a Lateral Approach. Arthroscopy Techniques. 2021. DOI: 10.1016/j.eats.2020.11.018

[182] Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model. Journal of Clinical Medicine. 2019. DOI: 10.3390/jcm8122093

[183] The Effect of Anterior Cruciate Ligament Deficiency and Reconstruction on the Patellofemoral Joint. The American Journal of Sports Medicine. 2008. DOI: 10.1177/0363546508314404

[185] Medial patellofemoral ligament reconstruction for patellar instability in patients with hypermobility. The Journal of Bone and Joint Surgery. British volume. 2012. DOI: 10.1302/0301-620x.94b12.29562

[187] MPFL Reconstruction and Implant-Mediated Guided Growth in Skeletally Immature Patients With Patellar Instability and Genu Valgum. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465231222934

[188] Adding Tibial Tuberosity Medialization to Medial Patellofemoral Ligament Reconstruction Reduces Lateral Patellar Maltracking During Multidirectional Motion in a Computational Simulation Model. Arthroscopy, Sports Medicine, and Rehabilitation. 2023. DOI: 10.1016/j.asmr.2023.100753

[191] Biomechanical Analysis of Current Medial Patellofemoral Ligament Reconstruction Techniques using Human Gracilis Allograft. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.04.035

[192] Relationship between Graft Force and Tuberosity Position Following MPFL Reconstruction. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.026

[193] Quantitative gait analysis in patients with medial patellar instability following lateral retinacular release. Knee Surgery, Sports Traumatology, Arthroscopy. 1997. DOI: 10.1007/s001670050034

[194] Biomechanical Comparison of 2 Patellar Fixation Techniques in Medial Patellofemoral Ligament Reconstruction: Transosseous Sutures vs Suture Anchors. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211041404

[196] Soft‐tissue fixation is not inferior to suture‐anchor fixation in reconstruction of the medial patellofemoral ligament using a nonresorbable suture tape. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-07120-1

[198] Evaluating the Impact of Graft Tensioning and Leg Positioning in Medial Patellofemoral Ligament Reconstruction on Patellofemoral Pressure Profile: A Systematic Review and Meta‐analysis. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.01.066

[199] MPFL Repair Versus Rehabilitation After Acute First-Time Patellar Dislocation: A Systematic Review And Meta-Analysis. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.313

[201] Fluoroscopic control allows for precise tunnel positioning in MPFL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3613-9

[202] In Vivo Length Changes Between the Attachments of the Medial Patellofemoral Complex Fibers in Knees With Anatomic Risk Factors for Patellar Instability. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231165296

[203] A Comparison of Proximal Patellar Realignment vs. Medial Patellofemoral Ligament Reconstruction. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.24.00112

[204] Medial Patellofemoral Ligament Reconstruction Combined With Distal Realignment for Recurrent Dislocations of the Patella: 5-Year Results of a Randomized Controlled Trial. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546516666352

[205] Patients who undergo tibial tubercle anteromedialization with medial patellofemoral ligament reconstruction demonstrate similar rates of return to sport compared to isolated MPFL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12051

[207] A modified Delphi consensus statement on patellar instability: part II. The Bone & Joint Journal. 2023. DOI: 10.1302/0301-620x.105b12.bjj-2023-0110.r1

[208] Systematic Review of Medial Patellofemoral Ligament Reconstruction Techniques: Comparison of Patellar Bone Socket and Cortical Surface Fixation Techniques. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.150

[209] MPFL repair after acute first‐time patellar dislocation results in lower redislocation rates and less knee pain compared to rehabilitation: a systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-07222-w

[210] Comparison of double bundle semitendinosus technique and pedicled quadriceps technique in patellar instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.12619

[211] Surgical reconstruction of the medial patellofemoral ligament. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2015.06.030

[212] Cost-Effectiveness of Medial Patellofemoral Ligament Reconstruction for First-Time Patellar Dislocations: A Markov Analysis. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251350394

[213] Radiographic images are inapplicable for a precise evaluation of the femoral tunnel position following MPFL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05378-6

[214] Opioid Prescription Patterns Following Medial Patellofemoral Ligament Reconstruction in Pediatric Patients: A 13-Year National Database Analysis. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00134

[215] Patient Specific Psychological Characteristics and Personality Structure Affect Postoperative Outcomes and Return to Sport Following Isolated Medial Patellofemoral Ligament Reconstruction. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100735

[216] Combined Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Reconstruction for Recurrent Lateral Patellar Instability in Patients With Multiple Anatomic Risk Factors. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.02.049

[217] The double-pulley technique for anatomical double-bundled medial patellofemoral ligament reconstruction. Injury. 2015. DOI: 10.1016/j.injury.2015.04.017

[220] Adolescent Medial Patellofemoral Ligament Reconstruction: A Comparison of the Use of Autograft Versus Allograft Hamstring. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118774272

[224] Reconstruction of the Medial Patellofemoral Ligament for Treatment of Patellofemoral Instability: A Systematic Review. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509353132

[225] Paper #65: Allograft Versus Autograft for Medial Patellofemoral Ligament Reconstruction. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.054

[226] Isolated and Combined Medial Patellofemoral Ligament Reconstruction in Revision Surgery for Patellofemoral Instability. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513498572

[229] Lateral Patellar Instability. Journal of Bone and Joint Surgery. 2023. DOI: 10.2106/jbjs.22.00756

[231] Return to Sport Following Medial Patellofemoral Ligament Reconstruction. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.027

[235] At 10-Year Minimum Follow-Up, One-Third of Patients Have Patellofemoral Arthritis After Isolated Medial Patellofemoral Ligament Reconstruction Using Gracilis Tendon Autograft. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2023. DOI: 10.1016/j.arthro.2022.07.021

[236] Medial Patellofemoral Reconstruction Techniques for Patellar Instability. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.01.006

[238] Medial Patellofemoral Ligament Reconstruction Using Pedicled Quadriceps Tendon Autograft Yields Similar Clinical and Patient‐Reported Outcomes but Less Donor‐Site Morbidity Compared With Gracilis Tendon Autograft. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.07.006

[252] Satisfactory midterm clinical results and low incidence of patellofemoral arthritis after MPFL reconstruction for patellar instability, in patients with low‐grade trochlear dysplasia. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70101

[253] Adding a tibial tubercle osteotomy with anteromedialisation to medial patellofemoral ligament reconstruction does not impact patient-reported outcomes in the treatment of patellar instability. Journal of ISAKOS. 2022. DOI: 10.1016/j.jisako.2021.10.004

[256] Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Has a Lower Risk of Recurrent Instability Requiring Revision Stabilization at 2 Years Than Either Procedure Alone. Arthroscopy, Sports Medicine, and Rehabilitation. 2024. DOI: 10.1016/j.asmr.2024.100994

[258] Revision surgery for failed medial patellofemoral ligament reconstruction results in better disease‐specific outcome scores when performed for recurrent instability than for patellofemoral pain or limited range of motion. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06734-1

[259] Outcomes following Medial Patellofemoral Ligament Reconstruction with Allograft (177). Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00296

[260] Podium Presentation Title: Outcomes for Medial Patellofemoral Ligament Reconstruction with Concomitant Tibial Tubercle Osteotomy for Failed Patellar Stabilization versus Primary Medial Patellofemoral Ligament Reconstruction with Concomitant Tibial Tubercle Osteotomy. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.01.081

[261] Paper 19: Outcomes for Primary versus Revision Medial Patellofemoral Ligament Reconstruction with Concomitant Tibial Tubercle Osteotomy. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00557

[264] Clinical outcomes of medial patellofemoral ligament repair in recurrent (chronic) lateral patella dislocations. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1516-y

[265] Failure Analysis in Patients With Patellar Redislocation After Primary Isolated Medial Patellofemoral Ligament Reconstruction. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120926178

[267] Durable patellar stability and high patient‐reported success at minimum 5‐year follow‐up after isolated suture tape MPFL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70466

[269] Concomitant Tibial Tubercle Osteotomy Reduces the Risk of Revision Surgery After Medial Patellofemoral Ligament Reconstruction for the Treatment of Patellar Instability. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.02.006

[271] Recurrent patellofemoral instability rates after MPFL reconstruction techniques are in the range of instability rates after other soft tissue realignment techniques. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05656-3

[273] Clinical outcomes after revision surgery for medial patellofemoral ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4477-y

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