Lateral Patellofemoral Ligament Reconstruction: Anatomy, Biomechanics, Indications and Surgical Techniques

With the exponential increase in the arthroscopic treatment of medial patellar instability through lateral sided “capsular” releases, the iatrogenic upsurge of lateral patellar dislocations has become more evident. Although few reports exist detailing the occurrence of this phenomenon due to traumatic or idiopathic etiologies, the vast majority (over 90%) are iatrogenic. Originally described by Kaplan and later by Reider, the lateral patellofemoral ligament (LPFL) constitutes one of the main stabilizers for medial patellar translation. Thus, understanding the anatomy and biomechanics of the LPFL is of utmost importance as reconstruction can potentially restore patellar instability and improve function in cases when this mechanism is compromised. However, few studies have sought to thoroughly describe the intricate anatomy and biomechanics of the LPFL to this end. The purpose of this article was to review the evidence on the anatomy of the LPFL and the lateral retinaculum, its biomechanical behavior, and previously reported surgical approaches to LPFL reconstruction.