MPFL Reconstruction and Patellofemoral Chondral Status

Lateral patellar dislocation is a relatively common knee injury in children and adolescents (Nietosvaara et al., J Pediatr Orthop 14(4):513–5, 1994; Fithian et al., Am J Sports Med 32(5):1114–21, 2004), and it may lead to recurrent patellar instability and functional disability (Macnab, J Bone Joint Surg Am 34:957–67, 1952; Hawkins et al., Am J Sports Med 14(2):117–20, 1986). Furthermore, most patients tend to have articular cartilage lesions in their patellofemoral (PF) joint (Nomura et al., Arthroscopy 19(7):717–21, 2003); these lesions get worse with time and lead to patellofemoral osteoarthritis (PFOA) (Nomura and Inoue, Osteoarthr Cartil 13(11):1029–36, 2005; Salonen et al., Am J Sports Med 45(6):1376–82, 2017). The therapeutic objectives would be preventing further dislocation, improving subjective apprehension, and reducing the risk of future osteoarthritis (OA). Numerous surgical procedures for stabilizing an unstable patella have been reported for over a hundred years. However, few procedures have demonstrated the prevention of further aggravation of osteoarthritis. The medial patellofemoral ligament (MPFL) has been regarded as a primary restraint for lateral displacement of the patella, and reconstructing an MPFL has become the first choice of treatment in patellar instability. The present chapter focuses on the current status of MPFL reconstruction, especially from a viewpoint of its possibility for preventing future OA.