Skip to main content

Patellofemoral Instability Surgery Complications: How to Avoid Them

  • Chapter
  • First Online:
  • 905 Accesses

Abstract

Both soft tissue and bone anatomy confer stability to the patella during the knee arc of motion. While high-energy trauma can result in damage to these constraints, low-energy forces can also result in recurrent patellar instability if there is underlying pathology to the basic architecture. Maltracking, or malalignment, of the patellofemoral articulation can not only contribute to potential instability but can also predispose to excessive cartilage wear, resulting in the progression of chondromalacia-related disease and pain. While there are a myriad of soft tissue, bone stabilization, and realignment procedures that can confer stability to the patellofemoral joint, these procedures also have inherent risks and potential complications. This chapter details the most commonly observed complications reported in the literature associated with patellofemoral surgery as it pertains to soft tissue and bony stabilization and realignment procedures. It will also review the technical causes of these complications and provide guidance on how to avoid and troubleshoot their occurrence in the operating room.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Ahmad CS, Stein BE, Matuz D, Henry JH. Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases. Am.J. Sports Med. 2000;28:804–10.

    Article  CAS  Google Scholar 

  2. Arendt EA, Moeller A, Agel J. Clinical outcomes of medial patellofemoral ligament repair in recurrent (chronic) lateral patella dislocations. Knee Surg Sports Traumatol Arthrosc. 2011;19:1909–14.

    Article  Google Scholar 

  3. Christiansen SE, Jakobsen BW, Lund B, Lind M. Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy. 2008;24:881–7.

    Article  Google Scholar 

  4. Schiphouwer L, Rood A, Tigchelaar S, Koeter S. Complications of medial patellofemoral ligament reconstruction using two transverse patellar tunnels. Knee Surg Sports Traumatol Arthrosc. 2016;25(1):245–50.

    Article  Google Scholar 

  5. Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2012;40:1916–23.

    Article  Google Scholar 

  6. Mulliez A, Lambrecht D, Verbruggen D, Van Der Straeten C, Verdonk P, Victor J. Clinical outcome in MPFL reconstruction with and without tuberositas transposition. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2708–14. https://doi.org/10.1007/s00167-015-3654-0.

    Article  CAS  PubMed  Google Scholar 

  7. Panni AS, Alam M, Cerciello S, Vasso M, Maffulli N. Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med. 2011;39:2647–55.

    Article  Google Scholar 

  8. Parikh SN, Nathan ST, Wall EJ, Eismann EA. Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med. 2013;41:1030–8.

    Article  Google Scholar 

  9. Mountney J, Senavongse W, Amis AA, Thomas NP. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br. 2005;87:36–40.

    Article  CAS  Google Scholar 

  10. Russo F, Doan J, Chase DC, Farnsworth CL, Pennock AT. Medial patellofemoral ligament reconstruction: fixation technique biomechanics. J Knee Surg. 2016;29:303–9.

    Article  Google Scholar 

  11. Russ SD, Tompkins M, Nuckley D, Macalena J. Biomechanical comparison of patellar fixation techniques in medial patellofemoral ligament reconstruction. Am J Sports Med. 2015;43:195–9.

    Article  Google Scholar 

  12. Steensen RN, Dopirak RM, Maurus PB. A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft. Arthroscopy. 2005;21:365–70.

    Article  Google Scholar 

  13. Vavalle G, Capozzi M. Isolated reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon. J Orthop Traumatol. 2016;17:155–62.

    Article  Google Scholar 

  14. Schottle PB, Romero J, Schmeling A, Weiler A. Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg. 2008;128:479–84.

    Article  Google Scholar 

  15. Burrus MT, Werner BC, Conte EJ, Diduch DR. Troubleshooting the femoral attachment during medial patellofemoral ligament reconstruction: location, location, location. Orthop J Sports Med. 2015;3:2325967115569198.

    Article  Google Scholar 

  16. Stephen JM, Kaider D, Lumpaopong P, Deehan DJ, Amis AA. The effect of femoral tunnel position and graft tension on patellar contact mechanics and kinematics after medial patellofemoral ligament reconstruction. Am J Sports Med. 2014;42:364–72.

    Article  Google Scholar 

  17. Elias JJ, Cosgarea AJ. Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med. 2006;34:1478–85.

    Article  Google Scholar 

  18. Ronga M, Oliva F, Longo UG, Testa V, Capasso G, Maffulli N. Isolated medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2009;37:1735–42.

    Article  Google Scholar 

  19. Burrus MT, Werner BC, Cancienne JM, Gwathmey FW, Diduch DR. MPFL graft fixation in low degrees of knee flexion minimizes errors made in the femoral location. Knee Surg Sports Traumatol Arthrosc. 2016;25(10):3092–8.

    Article  Google Scholar 

  20. Hughston JC, Deese M. Medial subluxation of the patella as a complication of lateral retinacular release. Am J Sports Med. 1988;16:383–8.

    Article  CAS  Google Scholar 

  21. Shellock FG, Mink JH, Deutsch AL, Fox JM. Patellar tracking abnormalities: clinical experience with kinematic MR imaging in 130 patients. Radiology. 1989;172:799–804.

    Article  CAS  Google Scholar 

  22. Sanchis-Alfonso V, Montesinos-Berry E, Monllau JC, Merchant AC. Results of isolated lateral retinacular reconstruction for iatrogenic medial patellar instability. Arthroscopy. 2015;31:422–7.

    Article  Google Scholar 

  23. Teitge RA, Torga SR. Lateral patellofemoral ligament reconstruction. Arthroscopy. 2004;20:998–1002.

    Article  Google Scholar 

  24. Payne J, Rimmke N, Schmitt LC, Flanigan DC, Magnussen RA. The incidence of complications of tibial tubercle osteotomy: a systematic review. Arthroscopy. 2015;31:1819–25.

    Article  Google Scholar 

  25. Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP. Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med. 1997;25:533–7.

    Article  CAS  Google Scholar 

  26. Bellemans J, Cauwenberghs F, Witvrouw E, Brys P, Victor J. Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment. Am J Sports Med. 1997;25:375–81.

    Article  CAS  Google Scholar 

  27. Zura R, Xiong Z, Einhorn T, Watson JT, Ostrum RF, Prayson MJ, et al. Epidemiology of fracture nonunion in 18 human bones. JAMA Surg. 2016;151(11):e162775.

    Article  Google Scholar 

  28. Magnussen RA, De Simone V, Lustig S, Neyret P, Flanigan DC. Treatment of patella Alta in patients with episodic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014;22:2545–50.

    Article  Google Scholar 

  29. Fisher TF, Waterman BR, Orr JD, Holland CA, Bader J, Belmont PJ Jr. Tibial tubercle osteotomy for patellar chondral pathology in an active United States military population. Arthroscopy. 2016;32(11):2342–9.

    Article  Google Scholar 

  30. McNamara I, Bua N, Smith TO, Ali K, Donell ST. Deepening trochleoplasty with a thick osteochondral flap for patellar instability: clinical and functional outcomes at a mean 6-year follow-up. Am J Sports Med. 2015;43:2706–13.

    Article  Google Scholar 

  31. Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc. 2005;13:529–33.

    Article  CAS  Google Scholar 

  32. Donell ST, Joseph G, Hing CB, Marshall TJ. Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results. Knee. 2006;13:266–73.

    Article  Google Scholar 

  33. von Knoch F, Bohm T, Burgi ML, von Knoch M, Bereiter H. Trochleoplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Joint Surg Br. 2006;88:1331–5.

    Article  Google Scholar 

  34. Ntagiopoulos PG, Byn P, Dejour D. Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J Sports Med. 2013;41:998–1004.

    Article  Google Scholar 

  35. Burrus M, Tompkins M, Hinckel B, Diduch DR, Arendt EA. Repair and reconstruction of the medial patellofemoral ligament for treatment of lateral patellar dislocations: Surgical techniques and clinical results. In: Scott WN, editor. Insall and scott: surgery of the knee. 6th ed. Philadelphia: Elsevier; 2017. p. 939–53.

    Google Scholar 

  36. Burrus M, Carstensen S, Diduch DR. Trochleoplasty. In: Browne J, Owens B, editors. Operative techniques: knee surgery. Philadelphia: Elsevier. In Press.

    Google Scholar 

  37. Utting MR, Mulford JS, Eldridge JD. A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Joint Surg Br. 2008;90:180–5.

    Article  CAS  Google Scholar 

  38. Dejour D, Saggin P. The sulcus deepening trochleoplasty-the Lyon’s procedure. Int Orthop. 2010;34:311–6.

    Article  Google Scholar 

  39. Fucentese SF, Zingg PO, Schmitt J, Pfirrmann CW, Meyer DC, Koch PP. Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19:1655–61.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to David R. Diduch or Brian C. Werner .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Laidlaw, M.S., Diduch, D.R., Werner, B.C. (2019). Patellofemoral Instability Surgery Complications: How to Avoid Them. In: Shubin Stein, B., Strickland, S. (eds) Patellofemoral Pain and Instability. Springer, Cham. https://doi.org/10.1007/978-3-319-97640-2_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-97640-2_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97639-6

  • Online ISBN: 978-3-319-97640-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics