Complications of Medial Patellofemoral Ligament Reconstruction: Common Technical Errors and Factors for Success
AAOS Exhibit Selection
Miho J. Tanaka, MD; Matthew J. Bollier, MD; Jack T. Andrish, MD; John P. Fulkerson, MD; Andrew J. Cosgarea, MD


Background: The role of medial patellofemoral ligament reconstruction in reestablishing patellofemoral joint stability has recently been reported with increasing frequency. The purpose of this study was to review the reported complications of medial patellofemoral ligament reconstruction, highlight the common technical errors, and discuss the potential complications that can arise from this procedure.

Methods: We review the literature on medial patellofemoral ligament reconstruction, including the reported causes of failure. In addition, we present three cases and discuss the multiple factors that are crucial for success, including patient selection, tunnel placement, graft isometry, and determination of the need for concurrent realignment surgery.

Results: The principles of surgical management require a thorough understanding of proper patient selection and of the interaction between the roles of the osseous and soft-tissue restraints on the patella. Creating a logical treatment algorithm based on pathoanatomy can elucidate the need for concurrent distal realignment procedures. Tunnel positioning is critical in recreating appropriate patellofemoral alignment. The reported complications include patellofemoral arthrosis, graft impingement, and graft failure.

Conclusions: Many of the complications that can arise from medial patellofemoral ligament reconstruction are the result of technical error and can be avoided by understanding the potential complications associated with this procedure.


  • Investigation performed at the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland

  • Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Enter your JBJS login information below.
Please note that your username is the email address you provided when you registered.

List of OpenAthens registered sites, including contact details.