Technique for Revision Lateral Patellofemoral Complex Reconstruction After Failed Primary Lateral Patellofemoral Ligament Reconstruction for Iatrogenic Medial Patellar Instability.

Abstract

Iatrogenic medial patellar instability is a rare complication after medial patellofemoral ligament reconstruction, often resulting from inadvertent injury to the lateral patellofemoral complex. This Technical Note describes a procedure for medial patellar instability after anterior cruciate ligament reconstruction with bone patellar bone autograft harvest, after failed primary lateral patellofemoral ligament, reconstruction, and tibial tubercle distalization for patella alta. A revision procedure is performed using a hybrid allograft-autograft construct made up of a double-limbed semitendinosus allograft for lateral patellofemoral ligament reconstruction combined with an iliotibial band autograft to separately reconstruct the lateral patellotibial ligament and augment the lateral capsular imbrication. This Technical Note discusses the surgical technique, radiographic evaluation, and biomechanical considerations associated with revision lateral patellofemoral complex reconstruction.