The Role of Medial Patellofemoral Ligament Repair and Imbrication.

Repair, reefing, and advancement of the medial patellofemoral ligament (MPFL) and medial retinacular structures can be performed as an isolated procedure or in conjunction with distal realignment procedures for patients with patellar instability. Although various operative techniques have been described, understanding the appropriate clinical indications and MPFL injury patterns ultimately determines the success or failure of the procedure. MPFL repair is best indicated in the acute setting, particularly if there is a patella- or femoral-based avulsion. If MPFL repair is being considered, and there is no evidence of avulsion on plain radiographs, magnetic resonance imaging can be used to examine the pattern and extent of the MPFL injury. In cases of chronic patellar instability, medial retinacular reefing or imbrication is best considered in conjunction with other procedures that address common pathology associated with chronic instability. These procedures include distal realignment, trochleoplasty, and distal femoral osteotomy.