Lateral Patellofemoral Ligament (LPFL) reconstruction is a surgical procedure that is intended to address chronic lateral patellar instability. This condition is usually a sequela of an injury or congenital malalignment of the patella, which causes repeated dislocations or subluxations.

Indications for LPFL Reconstruction

1.     Chronic Lateral Patellar Instability: Chronic patellar instability or recurrent patellar subluxation that fails to improve with conservative management.

2.     Failed Previous Surgical Interventions: Those who have had other surgeries and the condition remains unchanged.

3.     Anatomical Abnormalities: Abnormalities present at birth or developed over time that affect the knee joint and lead to excessive lateral patellar movement.

Preoperative Considerations

1.     Clinical Evaluation: A complete examination of the patellar tracking, ligamentous laxity and muscle strength.

2.     Imaging Studies: MRI and CT scans to assess the soft tissue and the bone positioning. X-rays are also helpful in evaluating the height of the patella and trochlear dysplasia.

3.     Conservative Management: Previous treatments include physical therapy, bracing and activity modification.

Surgical Technique

1.     Anesthesia: Local or epidural anesthesia.

2.     Patient Positioning: Lying down with the legs elevated and a tourniquet applied to the thigh.

3.     Graft Selection: Autograft from the hamstring tendons or allograft may be used.

4.     Incision: An incision is made either laterally or medially based on the approach and anatomical considerations.

5.     Graft Harvesting: If an autograft is to be used, it is then harvested, prepared, and shaped.

6.     Tunnel Creation: The graft is fixed in the patella and femur using bone tunnels or anchors.

7.     Graft Fixation: The graft is then threaded through the tunnels and fixed with screws, buttons or anchors.

8.     Tensioning: The graft is tensioned in a manner that will provide stability without causing excessive tightening around the knee joint.

9.     Wound Closure: The incision is closed in layers, and the area is covered with sterile dressing.

Postoperative Care

1.     Immobilization: A knee brace or immobilizer is applied to prevent motion at the site of repair during the early phase.

2.     Rehabilitation: Initial care involves passive stretching and range of motion exercises, which progress to active stretching and strengthening, and finally to functional training.

3.     Weight Bearing: Incremental increase from toe touch to full weight bearing as tolerated.

4.     Monitoring: Subsequent visits to evaluate the progress of healing and the level of functions.

Complications

1.     Infection: Like with any surgery, there is always a possibility of infection.

2.     Graft Failure: A risk of graft extending or tearing, which may cause recurrent instability.

3.     Stiffness: Rehabilitation complications or over- scarred tissues may cause knee stiffness.

4.     Pain: Chronic pain in the region of the patella or the site of the graft harvest.

Outcomes

The results of LPFL reconstruction are usually good, with enhanced stability and function of the patella. The success rates are influenced by the right patient, proper surgical procedures, and compliance with the physiotherapy regime.

Summary

LPFL reconstruction is a specific surgery that aims at treating lateral patellar instability. It entails making an incision and then suturing a graft to reconstruct the lateral patellofemoral ligament to enhance the stability of the patella and minimize the chance of dislocation. Appropriate patient choice, accurate surgical method, and thorough postoperative management are essential for achieving the best results.