Anatomical reconstruction of the medial patellofemoral ligament during subvastus approach in total knee arthroplasty: A technique to improve patellar tracking

Abstract

Background: Patellar maltracking remains a significant complication following total knee arthroplasty (TKA), often leading to anterior knee pain, instability, and accelerated polyethylene wear. While several intraoperative adjustments—such as external rotation of components and lateral release—are standard, they may be insufficient in cases of severe pre-existing instability. The medial patellofemoral ligament (MPFL) is the primary passive restraint against lateral patellar displacement. We present a surgical technique combining the quadriceps-sparing subvastus approach with anatomical MPFL reconstruction to optimize patellofemoral kinematics during primary TKA