Editorial Commentary: The "F" in MPFL (Medial Patellofemoral Ligament) Reconstruction-How Should We Fix It and Does It Matter?

Our understanding of the medial patellofemoral complex anatomy has evolved significantly over the past several decades, and this has informed our current surgical approach to management of lateral patellar instability. Medial patellofemoral ligament reconstruction remains the gold standard for decreasing the risk of secondary patellar dislocation and returning patients to active physical function. However, concerns about isometry, overconstraint, secondary arthrosis, and surgical-site morbidity remain with femoral socket fixation, particularly when patella alta, rotational malalignment, or hypermobility is present. Medial patellofemoral ligament reconstruction with soft-tissue fixation, on either the patellar or femoral side, may mitigate some of these risks by offering a more dynamic checkrein to lateral translation. However, longer-term studies are required to determine comparative efficacy with varying surgical techniques, and the ideal graft tension and degree of knee flexion during fixation have not yet been determined.