Return to Activity After Medial Patellofemoral Ligament Repair or Reconstruction


      This study aimed to determine the ability of patients to return to activity after medial patellofemoral ligament (MPFL) reconstruction or repair for patellar instability.


      A systematic review was performed using multiple databases. Studies reporting outcomes with Tegner scores after repair or reconstruction of the MPFL were included. Surgical technique, Tegner scores, and episodes of recurrent patellar instability were recorded.


      Ten articles with a total of 402 patients were included. The mean preoperative Tegner score was 4.7 (2.9 to 7.5). The mean postoperative Tegner score was 5.8 (4.0 to 7.7). Forty-nine patients (12.2%) had a recurrent episode of instability, 11 of whom required additional corrective procedures. There was a statistically significant larger failure rate among those who underwent MPFL repair (26.9%) than those who underwent reconstruction (6.6%) or medial retinacular repair/plication (16.5%).


      Recurrent dislocation was higher in patients who underwent MPFL repair rather than reconstruction. However, repair and reconstruction had similar Tegner scores. Repair or reconstruction of the soft tissue structures contributing to patellofemoral instability is successful in returning patients to preinjury activity levels.

      Level of Evidence

      Level IV, systematic review of Level II, III, and IV studies.
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        • Atkin D.M.
        • Fithian D.C.
        • Marangi K.S.
        • Stone M.L.
        • Dobson B.E.
        • Mendelsohn C.
        Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury.
        Am J Sports Med. 2000; 28: 472-479
        • Fithian D.C.
        • Paxton E.W.
        • Stone M.L.
        • et al.
        Epidemiology and natural history of acute patellar dislocation.
        Am J Sports Med. 2004; 32: 1114-1121
        • Waterman B.R.
        • Belmont Jr., P.J.
        • Owens B.D.
        Patellar dislocation in the United States: Role of sex, age, race, and athletic participation.
        J Knee Surg. 2012; 25: 51-57
        • Arendt E.A.
        • Fithian D.C.
        • Cohen E.
        Current concepts of lateral patella dislocation.
        Clin Sports Med. 2002; 21: 499-519
        • Cash J.D.
        • Hughston J.C.
        Treatment of acute patellar dislocation.
        Am J Sports Med. 1988; 16: 244-249
        • Hinton R.Y.
        • Sharma K.M.
        Acute and recurrent patellar instability in the young athlete.
        Orthop Clin North Am. 2003; 34: 385-396
        • Nikku R.
        • Nietosvaara Y.
        • Kallio P.E.
        • Aalto K.
        • Michelsson J.E.
        Operative versus closed treatment of primary dislocation of the patella. Similar 2-year results in 125 randomized patients.
        Acta Orthop Scand. 1997; 68: 419-423
        • Abramov M.
        • Stock H.
        Lateral patellar dislocation: Mechanism of disease, radiographic presentation, and management.
        Conn Med. 2013; 77: 235-238
        • Nikku R.
        • Nietosvaara Y.
        • Aalto K.
        • Kallio P.E.
        The mechanism of primary patellar dislocation: Trauma history of 126 patients.
        Acta Orthop. 2009; 80: 432-434
        • Bicos J.
        • Fulkerson J.P.
        • Amis A.
        Current concepts review: The medial patellofemoral ligament.
        Am J Sports Med. 2007; 35: 484-492
        • Philippot R.
        • Chouteau J.
        • Wegrzyn J.
        • Testa R.
        • Fessy M.H.
        • Moyen B.
        Medial patellofemoral ligament anatomy: Implications for its surgical reconstruction.
        Knee Surg Sport Traumatol Arthrosc. 2009; 17: 475-479
        • Amis A.A.
        • Firer P.
        • Mountney J.
        • Senavongse W.
        • Thomas N.P.
        Anatomy and biomechanics of the medial patellofemoral ligament.
        Knee. 2003; 10: 215-220
        • Conlan T.
        • Garth Jr., W.P.
        • Lemons J.E.
        Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee.
        J Bone Joint Surg Am. 1993; 75: 682-693
        • Desio S.M.
        • Burks R.T.
        • Bachus K.N.
        Soft tissue restraints to lateral patellar translation in the human knee.
        Am J Sports Med. 1998; 26: 59-65
        • Hautamaa P.V.
        • Fithian D.C.
        • Kaufman K.R.
        • Daniel D.M.
        • Pohlmeyer A.M.
        Medial soft tissue restraints in lateral patellar instability and repair.
        Clin Orthop Relat Res. 1998; : 174-182
        • Feller J.A.
        • Feagin Jr., J.A.
        • Garrett Jr., W.E.
        The medial patellofemoral ligament revisited: An anatomical study.
        Knee Surg Sport Traumatol Arthrosc. 1993; 1: 184-186
        • Nomura E.
        • Inoue M.
        • Osada N.
        Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment.
        Knee Surg Sport Traumatol Arthrosc. 2005; 13: 510-515
        • Smirk C.
        • Morris H.
        The anatomy and reconstruction of the medial patellofemoral ligament.
        Knee. 2003; 10: 221-227
        • Stefancin J.J.
        • Parker R.D.
        First-time traumatic patellar dislocation: A systematic review.
        Clin Orthop Relat Res. 2007; 455: 93-101
        • Arendt E.A.
        MPFL reconstruction for PF instability. The soft (tissue) approach.
        Orthop Traumatol Surg Res. 2009; 95: S97-S100
        • Dejour H.
        • Walch G.
        • Nove-Josserand L.
        • Guier C.
        Factors of patellar instability: An anatomic radiographic study.
        Knee Surg Sport Traumatol Arthrosc. 1994; 2: 19-26
        • Tegner Y.
        • Lysholm J.
        Rating systems in the evaluation of knee ligament injuries.
        Clin Orthop Relat Res. 1985; : 43-49
        • Obremskey W.T.
        • Pappas N.
        • Attallah-Wasif E.
        • Tornetta III, P.
        • Bhandari M.
        Level of evidence in orthopaedic journals.
        J Bone Joint Surg Am. 2005; 87: 2632-2638
        • Ahmad C.S.
        • Brown G.D.
        • Stein B.S.
        The docking technique for medial patellofemoral ligament reconstruction: Surgical technique and clinical outcome.
        Am J Sports Med. 2009; 37: 2021-2027
        • Buchner M.
        • Baudendistel B.
        • Sabo D.
        • Schmitt H.
        Acute traumatic primary patellar dislocation: Long-term results comparing conservative and surgical treatment.
        Clin J Sport Med. 2005; 15: 62-66
        • Camp C.L.
        • Krych A.J.
        • Dahm D.L.
        • Levy B.A.
        • Stuart M.J.
        Medial patellofemoral ligament repair for recurrent patellar dislocation.
        Am J Sports Med. 2010; 38: 2248-2254
        • Drez Jr., D.
        • Edwards T.B.
        • Williams C.S.
        Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation.
        Arthroscopy. 2001; 17: 298-306
        • Nelitz M.
        • Dreyhaupt J.
        • Reichel H.
        • Woelfle J.
        • Lippacher S.
        Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents with open growth plates: Surgical technique and clinical outcome.
        Am J Sports Med. 2013; 41: 58-63
        • Panagopoulos A.
        • van Niekerk L.
        • Triantafillopoulos I.K.
        MPFL reconstruction for recurrent patella dislocation: A new surgical technique and review of the literature.
        Int J Sports Med. 2008; 29: 359-365
        • Schöttle P.B.
        • Scheffler S.U.
        • Schwarck A.
        • Weiler A.
        Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: A preliminary report.
        Arthroscopy. 2006; 22: 1192-1198
        • Steiner T.M.
        • Torga-Spak R.
        • Teitge R.A.
        Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia.
        Am J Sports Med. 2006; 34: 1254-1261
        • Xie G.
        • Zhao J.
        • Huangfu X.
        • He Y.
        Medial patellofemoral ligament reconstruction using semitendinosus tendons: Polyester suture augmentation versus nonaugmentation.
        Am J Sports Med. 2012; 40: 1365-1374
        • Zhao J.
        • Huangfu X.
        • He Y.
        The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults.
        Am J Sports Med. 2012; 40: 1355-1364
        • Mäenpää H.
        • Lehto M.U.
        Surgery in acute patellar dislocation—evaluation of the effect of injury mechanism and family occurrence on the outcome of treatment.
        Br J Sports Med. 1995; 29: 239-241
        • White B.J.
        • Sherman O.H.
        Patellofemoral instability.
        Bull NYU Hosp Jt Dis. 2009; 67: 22-29
        • Shah J.N.
        • Howard J.S.
        • Flanigan D.C.
        • Brophy R.H.
        • Carey J.L.
        • 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: 1916-1923
        • Halbrecht J.L.
        Arthroscopic patella realignment: An all-inside technique.
        Arthroscopy. 2001; 17: 940-945
        • Sillanpaa P.J.
        • Mäenpää H.M.
        • Mattila V.M.
        • Visuri T.
        • Pihlajamaki H.
        Arthroscopic surgery for primary traumatic patellar dislocation: A prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up.
        Am J Sports Med. 2008; 36: 2301-2309
        • Haspl M.
        • Cicak N.
        • Klobucar H.
        • Pecina M.
        Fully arthroscopic stabilization of the patella.
        Arthroscopy. 2002; 18: E2
        • Arendt E.A.
        • Moeller A.
        • Agel J.
        Clinical outcomes of medial patellofemoral ligament repair in recurrent (chronic) lateral patella dislocations.
        Knee Surg Sport Traumatol Arthrosc. 2011; 19: 1909-1914
        • Ebied A.M.
        • El-Kholy W.
        Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability.
        Knee Surg Sport Traumatol Arthrosc. 2012; 20: 926-932