Techniques of medial retinacular repair and reconstruction

Insufficiency of the passive patellar restraints results in lateral patellar instability by allowing excessive lateral displacement of the patella. Although the surgical approach to patellar instability traditionally has been to realign the dynamic elements (muscle forces) that pull the patella laterally, newer techniques have sought to restore the integrity of key medial passive (ligamentous) stabilizers. An increasing body of evidence indicates that the chief medial ligamentous restraint is the medial patellofemoral ligament. The current authors examine the principles of medial retinacular repair and reconstruction as they relate to patellar stability. Individual techniques and approaches are discussed, including primary repair with or without augmentation, and reconstruction using autogenous tendon, allografts, and synthetic graft materials. These procedures share the common objective of addressing the essential lesion in lateral patellar instability to restore the normal passive restraints against lateral patellar displacement.