title: Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies.
abstract: Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.
authors.affiliation: Vicente Sanchis-Alfonso, Department of Orthopaedic Surgery, Hospital Arnau de Vilanova Valencia and Hospital 9 de Octubre, 46015 Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Sanchis-Alfonso
authors.affiliation: Vicente Sanchis-Alfonso, Department of Orthopaedic Surgery, Hospital Arnau de Vilanova Valencia and Hospital 9 de Octubre, 46015 Valencia, Spain.
authors.forename: Erik
authors.initials: E
authors.lastname: Montesinos-Berry
authors.affiliation: Vicente Sanchis-Alfonso, Department of Orthopaedic Surgery, Hospital Arnau de Vilanova Valencia and Hospital 9 de Octubre, 46015 Valencia, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ramirez-Fuentes
authors.affiliation: Vicente Sanchis-Alfonso, Department of Orthopaedic Surgery, Hospital Arnau de Vilanova Valencia and Hospital 9 de Octubre, 46015 Valencia, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Leal-Blanquet
authors.affiliation: Vicente Sanchis-Alfonso, Department of Orthopaedic Surgery, Hospital Arnau de Vilanova Valencia and Hospital 9 de Octubre, 46015 Valencia, Spain.
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Gelber
authors.affiliation: Vicente Sanchis-Alfonso, Department of Orthopaedic Surgery, Hospital Arnau de Vilanova Valencia and Hospital 9 de Octubre, 46015 Valencia, Spain.
authors.forename: Joan Carles
authors.initials: JC
authors.lastname: Monllau
keywords: 3D-CT in patellofemoral surgery; Failed medial patellofemoral ligament reconstruction; Medial patellofemoral ligament; Trochleoplasty