The Medial Patellofemoral Complex: Surgical anatomy, dynamic assessment, and considerations for reconstruction in the treatment of patellofemoral instability

Patellar instability is a difficult problem to treat due to its multifactorial nature. While soft tissue reconstruction has become the primary procedure in surgical management of patellar instability, many challenges remain in optimizing the outcomes of these procedures. Our understanding of the anatomy of the MPFL continues to evolve, now including the quadriceps tendon fibers and the term MPFC, to better represent this ligamentous complex that attaches to both the patella and quadriceps tendon. Our ability to assess patellar stability has implications for our diagnostic capabilities as well as our ability to intraoperatively assess the function of the MPFC, and promising dynamic imaging modalities have been described. The role of anatomic risk factors such as trochlear dysplasia, patella alta, and bony malalignment, and their influence on soft tissue reconstruction continue to need assessment to better identify the optimal surgical procedures to treat patellar instability in each patient