Editorial Commentary: Knee Medial Patellofemoral Ligament Reconstruction Does Not Always Result in the “Bee's Knees”

Reconstruction of the medial patellofemoral ligament has gained in popularity as a surgical technique to reconcile recurrent lateral patellar instability. This technique has shown success in a variety of settings including with concomitant osseous abnormalities. Despite the general good to excellent results with medial patellofemoral ligament reconstruction, a number of technical errors are still commonly made and may result in decreased range of motion, pain, chondrosis, and arthrofibrosis. In a recent study, the importance of knee flexion angle during final fixation of the graft is emphasized. Even with appropriate tunnel placement, and minimal tension on the graft, graft fixation performed at less than or greater than 60° of knee flexion results in medial patellar overload with risk of the aforementioned complications.