Anatomical Reconstruction of The Medial Patellofemoral Ligament for Recurrent Patellar Dislocation: Functional Evaluation and Follow-Up Analysis.

Anatomical Reconstruction of The Medial Patellofemoral Ligament for Recurrent Patellar Dislocation: Functional Evaluation and Follow-Up Analysis. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anatomical Reconstruction of The Medial Patellofemoral Ligament for Recurrent Patellar Dislocation: Functional Evaluation and Follow-Up Analysis. Sergio Iván Jasso-Campuzano, César Alejandro Jiménez-Aroche, José Ramón Jiménez-Castro, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7584490/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate functional outcomes, recurrence rates, and satisfaction in patients undergoing anatomical reconstruction of the MPFL. Methods Longitudinal observational study of 44 patients operated on between January 2010 and January 2024. Demographic and clinical variables were recorded; pre- and postoperative Kujala, Lysholm, Tegner, IKDC, and KOOS scales; ranges of motion; recurrence; and satisfaction. Analysis with paired/independent Student's t-test and chi-square/Fisher (p = 0.05). Results Significant improvement in all scores (p < 0.001). Recurrence rate 15.9% (n = 7) at 37.2 months of follow-up. High satisfaction in 65.8% (n = 29). Factors associated with complications: shorter stature, lower preoperative flexion, low target IKDC, and absence of previous activity. Conclusion Anatomical reconstruction of the MPFL offers favorable functional results and low recurrence in the Mexican population. Level of Evidence IV. Recurrence functional results anatomical reconstruction mpfl medial patellofemoral ligament patellofemoral instability Figures Figure 1 Figure 2 INTRODUCTION Patellofemoral instability (PFI) is a multifactorial condition that affects the knee joint. There is an alteration in the joint congruence of the patella with the femoral trochlear groove, characterized by recurrent episodes of patellar dislocation. This pathology frequently occurs in young female patients with a risky anatomy, understood as those patients with trochlear dysplasia, valgus angular deviation, and muscle hypotrophy. [ 1 , 2 ] It accounts for about 2% of knee injuries treated in emergency rooms, with an incidence of approximately 5.8 per 100,000 inhabitants. It is more common in young women and is associated with trochlear dysplasia, high patella, increased TT-TG distance, and hyperlaxity. Without proper treatment, it can progress to early patellofemoral osteoarthritis. [ 3 , 4 ] The evaluation of patellofemoral instability requires a detailed understanding of the pathoanatomical factors involved in this condition. Studies have shown that the presence of trochlear dysplasia, a high patella, and an increased TT-TG distance are determining factors in the recurrence of dislocation [ 5 , 6 ]. Knee biomechanics also play a crucial role, as the forces exerted on the patella during flexion and extension can contribute to its displacement and subsequent dislocation in cases of altered anatomy. New surgical techniques are emerging, and there is ongoing debate about which technique is most effective with the lowest rate of postoperative complications. It is important to identify the main cause of instability in each of our patients to determine whether they are candidates for isolated PMFL reconstruction or whether to work in conjunction with other techniques. Anatomical reconstruction of the LPFM has gained relevance due to its clinical and functional results, recurrence rate, and degree of satisfaction among patients with patellofemoral instability who undergo this surgery. [ 7 – 9 ] There are multiple studies demonstrating improvement in functional scores. A meta-analysis revealed that patients undergoing LPFM reconstruction had better long-term functional outcomes than those undergoing LPFM repair. [ 10 – 12 ] Preoperative and postoperative results in this surgical technique are evaluated using clinical scales such as Kujala, Lysholm, Tegner, IKDC, and KOOS, which measure the patient's function and quality of life. Multiple studies show a significant improvement in postoperative scores, hence, the importance of promoting this surgical technique. Several studies have conducted meta-analyses to compare the results of LPFM reconstruction with other techniques and conservative management. The results suggest that LPFM reconstruction is superior in terms of patellofemoral stability, quality of life, degree of satisfaction, and reduction in recurrence. [ 13 ] Despite its growing adoption, doubts remain about the optimal graft, fixation, and indications for complementary techniques. In Mexico, there is limited evidence of results in the local population; this study provides a series of 44 cases with an average follow-up of 37 months in order to verify that when performing the same surgical procedure in the Mexican population, we can aspire to a high success rate compared to that reported in the international literature, with good functional results, an average Kujala score above 80%, either as an isolated technique or in conjunction with other surgical techniques, and a recurrence rate of less than 20% (n = 7). MATERIALS & METHODS We conducted a longitudinal observational study analyzing the database of patients diagnosed with recurrent patellar dislocation who underwent surgery at our institution between 2010 and 2024 using the anatomical technique for medial patellofemoral ligament reconstruction. Recurrent dislocation was defined as more than one episode or symptoms of patellar instability. Patients with closed physis and positive apprehension sign were included. Patients with type D trochlear dysplasia according to the Djour classification, patients with grade 3 or 4 patellofemoral osteoarthritis, and severe varus or valgus angular deformities (more than 20°) were excluded. Conveniently, after the retrospective search, we had a total of 73 patients who underwent medial patellofemoral ligament reconstruction. However, with the inclusion and exclusion criteria mentioned above, we obtained a final sample of 44 patients who underwent postoperative medial patelofemoral ligament reconstruction using the anatomical technique. Description of Procedures A database is compiled from our institution's system with the ICD-10 diagnosis of: "bilateral patella dislocation, right patella dislocation, left patella dislocation, bilateral patella dislocation, right patella dislocation, left patella dislocation, right patella dislocation, left patella dislocation, recurrent right patella dislocation, recurrent left patella dislocation, right patella lateralization, left patella lateralization, right patella lateral subluxation, left patella subluxation”. Records are selected based on the inclusion criteria of this protocol, and pre-surgical files are compiled. The file is intentionally searched for a reconstruction of the medial patellofemoral ligament using an anatomical technique, considering an anatomical reconstruction to be one in which the graft is taken and fixed to the distal femur between the medial epicondyle and the adductor tubercle until its insertion in the upper twothirds of the patella (Fig. 1 ), and the pre-surgical functional scales of Kujala, Lysholm, Koos, IKDC, and Tegner are sought. If the pre-surgical information is not found, it is obtained later during the interview or phone call. The post-surgical functional scales are performed in a face-to-face interview or by phone call, and finally, a survey is conducted on the current level of satisfaction with the surgery. [ 14 – 18 ] Surgical Technique Under regional anesthesia and thigh ischemia, diagnostic arthroscopy was performed to evaluate the femorotibial and patellofemoral compartments, treating concomitant injuries. An autologous graft (semitendinosus/gracilis/quadriceps) was obtained according to availability and surgeon preference. The anatomical femoral site was located between the medial epicondyle and the adductor tubercle, guided by fluoroscopy. In the patella, fixation was performed in the upper two-thirds, avoiding anterior cortical violation. ( Fig. 1 ) Graft tension was verified at 30° of flexion, with patellar tracking follow-up without crepitus or subluxation. Variables and statistical analysis Demographic variables: age, sex, weight, height, laterality, etiology (traumatic/non traumatic), activity level (0 = no activity; 1 = moderate; 2 = high), and hyperlaxity. Clinical variables: pre- and postoperative flexion and extension ROM; Kujala, Lysholm, Tegner, subjective IKDC, and KOOS scales; recurrence; satisfaction. Statistical methods: extraction of electronic records and standardized interviews. Analysis by available cases without imputation; verification of normality (Shapiro-Wilk) and homogeneity (Levene). Pre vs. Postcomparisons with paired Student's t-test; associations with complications using chi-square or Fisher's exact test as expected; p < 0.05 as significant difference. SPSS v17 was used. This study followed STROBE recommendations for observational studies. RESULTS This study included 44 cases, of which 84.1% (n = 37) were female and 15.9% (n = 7) were male, with an average age of 22.5 ± 6.3 years. In terms of laterality, 43.2% (n = 19) of cases were on the right side and 56.8% (n = 25) on the left side. The etiology was traumatic in 48.8% (n = 21) of cases and non-traumatic in 51.2% (n = 23). The level of activity prior to surgery was distributed as follows: 63.9% (n = 28) inactive, 19.4% (n = 9) moderately active, and 16.7% (n = 7) highly active. Hyperlaxity was present in 70% (n = 31) of cases. ( Table 1 ) Functional results showed significant improvements in terms of preoperative and postoperative status. The average range of flexion increased from 120.48° preoperatively to 125.91° postoperatively, although this was not statistically significant (p = 0.11). The range of extension showed an improvement from 1.14° to -0.45°, without statistical significance (p = 0.09). Functional scores showed a statistically significant improvement. On the Kujala scale, they improved from an average of 59.23 ± 14.59 to 90.22 ± 10.23 (p < 0.001), thus confirming our hypothesis. We also found a statistical improvement in the other scales. for example, we found an improvement on the Tegner scale from 2.60 ± 1.27 to 4.34 ± 2.12 (p < 0.001), Lysholm from 52.98 ± 20.40 to 88.35 ± 12.26 (p < 0.001), subjective IKDC from 50.28 ± 18.43 to 84.89 ± 12.66 (p < 0.001), and KOOS from 56.91 ± 18.69 to 90.48 ± 9.44 (p < 0.001). ( Table 2 ) The overall recurrence rate was 15.9% (n = 7) at an average follow-up of 37 months (range: 5-159 months). Postoperative satisfaction levels were high, with 65.8% (n = 29) reporting high satisfaction with the surgery performed (Fig. 2 ). Prognostic factors associated with complications included female sex, with women having a higher risk of complications than men (p = 0.07), activity level, with complications being more common in those with no previous activity (p = 0.02), shorter stature (p = 0.03), lower preoperative flexion range (p = 0.001), and lower preoperative objective IKDC score (p = 0.04). ( Table 3 ) Postoperative satisfaction was associated with several factors. Female patients reported lower satisfaction (p = 0.03), as did those with a positive J sign (p = 0.06). Weight and duration of symptoms also affected the level of satisfaction, which was lower in lighter patients (p = 0.04) and those with longer-lasting symptoms (p = 0.04). These results highlight the importance of considering these prognostic factors when evaluating the effectiveness and outcomes of PMFL reconstruction in patients with patellofemoral instability. Table 1 Sample characteristics (n = 44). Variable Value Detail Age (years), mean ± SD 22.5 ± 6.3 — Sex, n (%) Female 37 (84.1%) Sex, n (%) Male 7 (15.9%) Side, n (%) Right 19 (43.2%) Side, n (%) Left 25 (56.8%) Etiology, n (%) Traumatic 21 (48.8%) Etiology, n (%) Non-traumatic 23 (51.2%) Activity level, n (%) 0 28 (63.9%) Activity level, n (%) 1 9 (19.4%) Activity level, n (%) 2 7 (16.7%) Hyperlaxity, n (%) Present 70% Table 2 All comparisons were performed using paired Student’s t-test. Reported values include the mean ± standard deviation (SD), absolute change (Δ), t-value, corresponding F-value (calculated as t²), and p-value. Associations with categorical variables, such as complications, were analyzed using chisquare or Fisher’s exact test, as appropriate. Scale Pre (Mean ± SD) Post (Mean ± SD) Absolute Δ t-value F-value p-value Kujala 59.23 ± 14.59 90.22 ± 10.23 + 30.99 11.54 133.08 p < 0.001 Lysholm 52.98 ± 20.40 88.35 ± 12.26 + 35.37 9.86 97.17 p < 0.001 Tegner 2.60 ± 1.27 4.34 ± 2.12 + 1.74 4.67 21.81 p < 0.001 Subjective IKDC 50.28 ± 18.43 84.89 ± 12.66 + 34.61 10.27 105.42 p < 0.001 KOOS 56.91 ± 18.69 90.48 ± 9.44 + 33.57 10.63 113.10 p < 0.001 Table 3 Comparison of demographic and preoperative clinical variables between patients with and without postoperative complications. Values are presented as mean ± standard deviation (SD) or number (percentage), as appropriate. ROM = range of motion; IKDC = International Knee Documentation Committee. Factor Complication: Yes Complication: No p-value Female sex, n (%) 8 (100%) 29 (80.6%) 0.07 Activity level, n 0.02 • 0 0 6 • 1 7 – • 2 16 – Height (cm), mean ± SD 156.2 ± 4.6 162.8 ± 7.7 0.03 Preoperative knee flexion ROM (°), mean ± SD 100.6 ± 38.2 124.8 ± 8.4 0.001 Preoperative objective IKDC, mean (SD) 1.29 (0.9) 2.0 (0.7) 0.04 DISCUSSION In this study, reconstruction of the medial patellofemoral ligament using an anatomical technique showed a significant improvement in knee stability and function in patients with patellofemoral instability. These findings are consistent with previous studies that have demonstrated the effectiveness of this surgical procedure. [ 19 – 20 ] For example, Zhao et al. (2021) [ 5 ] reported a similar improvement in Kujala and IKDC scores in patients undergoing MPFL reconstruction. Furthermore, in the same study, more than 80% of patients returned to their daily activities and sports, which supports our positive results in these metrics. However, the complication rate in this study was 15.9%, slightly lower than that reported by various authors such as Shah et al. (2012), [ 21 ] who found a complication rate of 26.1%. This difference could be attributed to variability in the type of graft used, the surgeon's experience, the patellar and femoral fixation method, and patient selection. Although our study was based on the Mexican population, which had a higher proportion of women, who in turn showed a greater predisposition to complications, we presented a lower complication rate compared to the international literature. Some authors, such as Navarini and Camp et al. [ 22 , 23 ] found a recurrence rate of 3.2–6.5%; however, these are small case series and consider more than one anatomical configuration in PMFL reconstruction. Postoperative satisfaction levels in our study were generally high, although women, patients with a positive J sign, and those with patellar chondromalacia had lower satisfaction, mainly due to a feeling of instability and stiffness, which is consistent with the findings of Yacuzzi et al. (2017), [ 24 ] who also observed a high degree of satisfaction (86%) after surgery, with a very low percentage of dissatisfaction (14%) due mainly to postoperative stiffness and arthrofibrosis. The degree of satisfaction of the patients in this study may be related to residual instability and postoperative rehabilitation time. Our cohort exhibited statistically significant improvements across all validated functional outcome measures. The Kujala score increased from a mean of 59.23 to 90.22, while the Lysholm score rose from 52.98 to 88.35, both indicating substantial enhancement in knee function. The Tegner activity scale improved from 2.60 to 4.34, reflecting a higher return to pre-injury activity levels. Similarly, the subjective IKDC score improved from 50.28 to 84.89, and the KOOS from 56.91 to 90.48, demonstrating broad functional recovery and reduction of symptoms. As expected and consistent with previously published literature, these findings confirm that surgical intervention resulted in clinically meaningful and sustained functional gains across all outcome instruments applied. An important limitation of our study was the lack of preoperative information. On several occasions, it was difficult to locate patients, and they did not remember the preoperative status of their knee. In addition, various surgeons with varying degrees of experience participated in this study, and it should be noted that the same graft was not used in all surgeries. All of this could influence the final functional results, recurrence rate, and degree of satisfaction with MCL reconstruction. The recurrence rate highlights the need for careful patient evaluation and selection, as well as consideration of additional surgical techniques to optimize outcomes. Compared with the existing literature, our findings are consistent, although variability in certain outcomes suggests areas for future research and improvements in clinical practice. CONCLUSIONS Anatomical reconstruction of the PMFL improves knee stability and function in patients with patellofemoral instability, with an average Kujala score of 90.22, high patient satisfaction, and an acceptable recurrence rate of 15.9% at an average follow-up of 37 months. Declarations Disclosures Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work . Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. Ethics approval and consent to participate The study was approved by the institutional research and ethics committee. Due to the retrospective nature of this manuscript, informed consent was not required from the selected patients; however, each of them had provided consent to undergo the surgical procedure. Consent for publication Not applicable. This manuscript does not contain any individual person’s data in any form (including images, videos, or personal details). Availability of data and materials The datasets supporting the conclusions of this article are available if requested. Competing interests The authors declare that they have no competing interests. Funding Not applicable. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions Jasso-Campuzano S.I.: Study conception and design, surgical procedures, data collection, critical revision of the manuscript. Jiménez-Aroche C.A.: Data analysis and interpretation, drafting of the manuscript, coordination of the study. Jiménez-Castro J.R.: Patient follow-up, data collection, preparation of tables and figures. Laffite-García H.: Statistical analysis, methodological support, manuscript editing. Villalobos-Córdova F.E.: Critical review for important intellectual content, supervision of the project, final approval of the manuscript. Acknowledgements The authors would like to thank the medical staff of the Orthopaedics and Traumatology Department of our institution for their valuable support in patient care and data collection. We also acknowledge the contribution of the Biostatistics Unit for their guidance in the statistical analysis. Authors' information - Affiliations: National Rehabilitation Institute Orthopedic Surgery, Sports Medicine Corresponsal Author: César A. Jiménez-Aroche MD, MS. Phone: +52 993 264 2324 e-mail: [email protected] Calz México-Xochimilco 289, ZP 14389 México City, México. References Guillén Morales JC, Araujo Espinoza GE, Lozano Lurita C, Torres Manrique AD. Resultados funcionales en la reconstrucción anatómica del ligamento patelofemoral medial en el tratamiento de la luxación patellar recurrente. Rev Soc Peru Ortop Traumatol. 2021;3:8–17. Hiemstra LA, Kerslake S, Lafave MR. Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 2016;24:3093–101. 10.1007/s00167-016-4346-0 . Yoo JD, Huh MH, Lee CW, Roh YH, D'Lima DD, Shin YS. Medial patellofemoral ligament reconstruction appears to be a better treatment than repair, proximal realignment, or conservative management for primary patellar dislocation: A network meta- analysis. Med (Baltimore. 2023;102. 10.1097/MD.0000000000035251 . Xu T, Zhu Y, Zhang L, Xie HQ, Fu W. Results of medial patellofemoral ligament reconstruction with and without tibial tubercle transfer in patellar instability: A systematic review and meta-analysis. Orthop Surg. 2023;15:2766–76. 10.1111/os.13870 . Zhao Z, Wang Y, Li J, Wang H, Bai X, Wang Q, Li Z. Clinical outcomes and prognostic factors in patients with recurrent patellar lateral dislocation treated with isolated medial patellofemoral ligament reconstruction: A retrospective single- center analysis. Orthop JSportsMed. 2021;9:2325967121995803. 10.1177/2325967121995803 . Bartsch A, Nüesch C, Rieger B, Mündermann A, Egloff C. Dynamic versus static medial patellofemoral ligament reconstruction technique in the treatment of recurrent patellar dislocation: a randomized clinical trial protocol. J Orthop Surg Res. 2022;17:345. 10.1186/s13018-022-03158-6 . Gondolfo R Jr, Emanuele HS, Guerreiro JPF, Queiroz AO, Danieli MV. Clinical results of medial patellofemoral ligament reconstruction. Acta Ortop Bras. 2022;30(10). 10.1590/1413-785220223003e241172 . Migliorini F, Trivellas A, Eschweiler J, Knobe M, Tingart M, Maffulli N. Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30:1282–91. 10.1007/s00167-021-06569-w . Migliorini F, Oliva F, Maffulli GD, Eschweiler J, Knobe M, Tingart M, Maffulli N. Isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability: analysis of outcomes and risk factors. J Orthop Surg Res. 2021;16:239. 10.1186/s13018-021-02383-9 . Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32:1114–21. 10.1177/0363546503260788 . Jiang J, Yi Z, Li J, Liu Y, Xia Y, Wu M. Medial patellofemoral ligament reconstruction is preferred to repair or reefing for first- time patellar dislocation: A systematic review and meta-analysis. Indian J Orthop. 2022;57:177–88. 10.1007/s43465-022-00770-w . Jos S, Shankar S, Anand R, Manathara LT, Paulose B. Outcomes of MPFL reconstruction with tibial tubercle transfer for recurrent patellar instability with high-grade trochlear dysplasia in Indian population. J Clin Orthop Trauma. 2021;20:101490. 10.1016/j.jcot.2021.101490 . Hao K, Feng A, Kong L, Wang F. Quality of life following medial patellofemoral ligament reconstruction combined with medial tibial tubercle transfer in patients with recurrent patellar dislocation: a retrospective comparative study. J Orthop Surg Res. 2022;17:416. 10.1186/s13018-022-03310-2 . Kujala UM, Jaakkola LH, Koskinen SK, et al. Scoring of patellofemoral disorders. Arthroscopy. 1993;9(2):159–63. 10.1016/S0749-8063(05)80366-4 . Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10(3):150–4. 10.1177/036354658201000306 . Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985, (198):43–9. Irrgang JJ, Anderson AF, Boland AL, et al. Development and validation of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2001;29(5):600–13. 10.1177/03635465010290051301 . Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS). J Orthop Sports Phys Ther. 1998;28(2):8896. 10.2519/jospt.1998.28.2.88 . Reddy G, Hayer PS, UlIslam S, Mehta NJ, Iqbal HJ, Stables G, Barton-Hanson NG. Outcomes of allograft medial patellofemoral ligament reconstruction in children and adolescents with hypermobility. Int J Appl Basic Med Res. 2022;12:161–6. 10.4103/ijabmr.ijabmr_25_22 . Romo-Rivera J, Rangel-Pérez LJ. Reconstrucción del ligamento patellofemoral medial con autoinjerto de tendón cuadricipital. Acta Ortop Mex. 2021;35:425–8. 10.35366/104569 . Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2012;40:1916–23. 10.1177/0363546512442330 . Navarini JP, Maestu R, Batista JP, Ocampo M, Ciliberto F, Rainaudi P. Reconstrucción de ligamento patelofemoral medial. Artroscopia. 2013;20:90–4. Camp CL, Krych AJ, Dahm DL, Levy BA, Stuart MJ. Medial patellofemoral ligament repair for recurrent patellar dislocation. Am J Sports Med. 2010;38:2248–54. 10.1177/0363546510378053 . Yacuzzi C, Palacios J, Zicaro JP, Oñativia I, Costa Paz M. Reconstrucción de Ligamento Patelofemoral Medial. Evaluación de resultados clínicos a 3 años de seguimiento. Artroscopia. 2017;24:65–708. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7584490","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":523440761,"identity":"36ade88a-ada0-4a2a-9282-8102b368e747","order_by":0,"name":"Sergio Iván Jasso-Campuzano","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Sergio","middleName":"Iván","lastName":"Jasso-Campuzano","suffix":""},{"id":523440762,"identity":"c2172bc6-817d-4da6-87d5-9e5624bd1ebb","order_by":1,"name":"César Alejandro Jiménez-Aroche","email":"data:image/png;base64,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","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"César","middleName":"Alejandro","lastName":"Jiménez-Aroche","suffix":""},{"id":523440763,"identity":"c0c97a96-f9d9-4662-bc79-e6ad2f372239","order_by":2,"name":"José Ramón Jiménez-Castro","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"Ramón","lastName":"Jiménez-Castro","suffix":""},{"id":523440764,"identity":"59033be6-56ae-4209-a5d8-f8aabc4ab7d4","order_by":3,"name":"Héctor Laffite-García","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Héctor","middleName":"","lastName":"Laffite-García","suffix":""},{"id":523440765,"identity":"878dd8d7-3d50-4df5-bcff-1c09ccf9f064","order_by":4,"name":"Félix Enrique Villalobos-Córdova","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Félix","middleName":"Enrique","lastName":"Villalobos-Córdova","suffix":""}],"badges":[],"createdAt":"2025-09-10 15:38:17","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7584490/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7584490/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95795178,"identity":"31d2e700-71a3-4b01-aa7c-e8ad19f4faab","added_by":"auto","created_at":"2025-11-13 07:41:10","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155034,"visible":true,"origin":"","legend":"","description":"","filename":"JOSRMPFLVs2declarations.docx","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/bfbf35a6991ed9b0b015bb2d.docx"},{"id":95802818,"identity":"7c6f7df9-daf4-48e9-8224-61d750252335","added_by":"auto","created_at":"2025-11-13 08:28:39","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6525,"visible":true,"origin":"","legend":"","description":"","filename":"89105e82b2c640bea1e89326e66865af.json","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/978abbc0506287250b8d7e3f.json"},{"id":95795182,"identity":"6e70a6af-a7f4-4c85-aab8-ce61fc997898","added_by":"auto","created_at":"2025-11-13 07:41:10","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80249,"visible":true,"origin":"","legend":"","description":"","filename":"89105e82b2c640bea1e89326e66865af1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/026b2ad3f8e32a6769fab7be.xml"},{"id":95795179,"identity":"19b408ec-30b8-4718-874d-3be539708b52","added_by":"auto","created_at":"2025-11-13 07:41:10","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":58711,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/e72fd50b706588397ccf83d7.png"},{"id":95802243,"identity":"e1accbaf-aa99-4bea-8f09-8b0ba1c3dc8c","added_by":"auto","created_at":"2025-11-13 08:27:15","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10514,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/afcf8a3164305c1631b5f141.png"},{"id":95795181,"identity":"c2aaac84-278f-4af9-9fa9-6aad074f8b41","added_by":"auto","created_at":"2025-11-13 07:41:10","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76887,"visible":true,"origin":"","legend":"","description":"","filename":"89105e82b2c640bea1e89326e66865af1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/81fb479c793e0843684cab39.xml"},{"id":95795183,"identity":"4ac9cf1b-2f80-4674-8991-8337710e9559","added_by":"auto","created_at":"2025-11-13 07:41:10","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84781,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/379053b761b843cc6d450f45.html"},{"id":95795180,"identity":"39ccb67e-433d-4bf2-80e6-7525420629dd","added_by":"auto","created_at":"2025-11-13 07:41:10","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":62427,"visible":true,"origin":"","legend":"\u003cp\u003eAnatomical reconstruction of the MPFL: femoral point between the medial epicondyle and the adductor tubercle; fixation in the upper two-thirds of the patella.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/3a1be0340588859ad3aedb5e.jpeg"},{"id":95802817,"identity":"d464ccd6-9808-4572-a26b-edff10d78b3d","added_by":"auto","created_at":"2025-11-13 08:28:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":52878,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative satisfaction showed high levels up to 65.8%\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/0069669296b5e37d28c0a29a.png"},{"id":95805509,"identity":"0d0815ac-e101-49d2-b133-f2f7a8f05c0c","added_by":"auto","created_at":"2025-11-13 08:41:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":802850,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7584490/v1/d24826dc-3b5b-4021-b265-1c644e2fceac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anatomical Reconstruction of The Medial Patellofemoral Ligament for Recurrent Patellar Dislocation: Functional Evaluation and Follow-Up Analysis.","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePatellofemoral instability (PFI) is a multifactorial condition that affects the knee joint. There is an alteration in the joint congruence of the patella with the femoral trochlear groove, characterized by recurrent episodes of patellar dislocation. This pathology frequently occurs in young female patients with a risky anatomy, understood as those patients with trochlear dysplasia, valgus angular deviation, and muscle hypotrophy. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] It accounts for about 2% of knee injuries treated in emergency rooms, with an incidence of approximately 5.8 per 100,000 inhabitants. It is more common in young women and is associated with trochlear dysplasia, high patella, increased TT-TG distance, and hyperlaxity. Without proper treatment, it can progress to early patellofemoral osteoarthritis. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe evaluation of patellofemoral instability requires a detailed understanding of the pathoanatomical factors involved in this condition. Studies have shown that the presence of trochlear dysplasia, a high patella, and an increased TT-TG distance are determining factors in the recurrence of dislocation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Knee biomechanics also play a crucial role, as the forces exerted on the patella during flexion and extension can contribute to its displacement and subsequent dislocation in cases of altered anatomy. New surgical techniques are emerging, and there is ongoing debate about which technique is most effective with the lowest rate of postoperative complications. It is important to identify the main cause of instability in each of our patients to determine whether they are candidates for isolated PMFL reconstruction or whether to work in conjunction with other techniques.\u003c/p\u003e\u003cp\u003eAnatomical reconstruction of the LPFM has gained relevance due to its clinical and functional results, recurrence rate, and degree of satisfaction among patients with patellofemoral instability who undergo this surgery. [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] There are multiple studies demonstrating improvement in functional scores. A meta-analysis revealed that patients undergoing LPFM reconstruction had better long-term functional outcomes than those undergoing LPFM repair. [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Preoperative and postoperative results in this surgical technique are evaluated using clinical scales such as Kujala, Lysholm, Tegner, IKDC, and KOOS, which measure the patient's function and quality of life. Multiple studies show a significant improvement in postoperative\u003c/p\u003e\u003cp\u003escores, hence, the importance of promoting this surgical technique.\u003c/p\u003e\u003cp\u003eSeveral studies have conducted meta-analyses to compare the results of LPFM reconstruction with other techniques and conservative management. The results suggest that LPFM reconstruction is superior in terms of patellofemoral stability, quality of life, degree of satisfaction, and reduction in recurrence. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Despite its growing adoption, doubts remain about the optimal graft, fixation, and indications for complementary techniques. In Mexico, there is limited evidence of results in the local population; this study provides a series of 44 cases with an average follow-up of 37 months in order to verify that when performing the same surgical procedure in the Mexican population, we can aspire to a high success rate compared to that reported in the international literature, with good functional results, an average Kujala score above 80%, either as an isolated technique or in conjunction with other surgical techniques, and a recurrence rate of less than 20% (n\u0026thinsp;=\u0026thinsp;7).\u003c/p\u003e"},{"header":"MATERIALS \u0026 METHODS","content":"\u003cp\u003eWe conducted a longitudinal observational study analyzing the database of patients diagnosed with recurrent patellar dislocation who underwent surgery at our institution between 2010 and 2024 using the anatomical technique for medial patellofemoral ligament reconstruction. Recurrent dislocation was defined as more than one episode or symptoms of patellar instability. Patients with closed physis and positive apprehension sign were included. Patients with type D trochlear dysplasia according to the Djour classification, patients with grade 3 or 4 patellofemoral osteoarthritis, and severe varus or valgus angular deformities (more than 20\u0026deg;) were excluded.\u003c/p\u003e\u003cp\u003eConveniently, after the retrospective search, we had a total of 73 patients who underwent medial patellofemoral ligament reconstruction. However, with the inclusion and exclusion criteria mentioned above, we obtained a final sample of 44 patients who underwent postoperative medial patelofemoral ligament reconstruction using the anatomical technique.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDescription of Procedures\u003c/h2\u003e\u003cp\u003eA database is compiled from our institution's system with the ICD-10 diagnosis of: \"bilateral patella dislocation, right patella dislocation, left patella dislocation, bilateral patella dislocation, right patella dislocation, left patella dislocation, right patella dislocation, left patella dislocation, recurrent right patella dislocation, recurrent left patella dislocation, right patella lateralization, left patella lateralization, right patella lateral subluxation, left patella subluxation\u0026rdquo;.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eRecords are selected based on the inclusion criteria of this protocol, and pre-surgical files are compiled. The file is intentionally searched for a reconstruction of the medial patellofemoral ligament using an anatomical technique, considering an anatomical reconstruction to be one in which the graft is taken and fixed to the distal femur between the medial epicondyle and the adductor tubercle until its insertion in the upper twothirds of the patella (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and the pre-surgical functional scales of Kujala, Lysholm, Koos, IKDC, and Tegner are sought. If the pre-surgical information is not found, it is obtained later during the interview or phone call. The post-surgical functional scales are performed in a face-to-face interview or by phone call, and finally, a survey is conducted on the current level of satisfaction with the surgery. [\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSurgical Technique\u003c/h3\u003e\n\u003cp\u003eUnder regional anesthesia and thigh ischemia, diagnostic arthroscopy was performed to evaluate the femorotibial and patellofemoral compartments, treating concomitant injuries. An autologous graft (semitendinosus/gracilis/quadriceps) was obtained according to availability and surgeon preference. The anatomical femoral site was located between the medial epicondyle and the adductor tubercle, guided by fluoroscopy. In the patella, fixation was performed in the upper two-thirds, avoiding anterior cortical violation. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e Graft tension was verified at 30\u0026deg; of flexion, with patellar tracking follow-up without crepitus or subluxation.\u003c/p\u003e\n\u003ch3\u003eVariables and statistical analysis\u003c/h3\u003e\n\u003cp\u003eDemographic variables: age, sex, weight, height, laterality, etiology (traumatic/non traumatic), activity level (0\u0026thinsp;=\u0026thinsp;no activity; 1\u0026thinsp;=\u0026thinsp;moderate; 2\u0026thinsp;=\u0026thinsp;high), and hyperlaxity. Clinical variables: pre- and postoperative flexion and extension ROM; Kujala, Lysholm, Tegner, subjective IKDC, and KOOS scales; recurrence; satisfaction.\u003c/p\u003e\u003cp\u003eStatistical methods: extraction of electronic records and standardized interviews. Analysis by available cases without imputation; verification of normality (Shapiro-Wilk) and homogeneity (Levene). Pre vs. Postcomparisons with paired Student's t-test; associations with complications using chi-square or Fisher's exact test as expected; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as significant difference. SPSS v17 was used. This study followed STROBE recommendations for observational studies.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis study included 44 cases, of which 84.1% (n\u0026thinsp;=\u0026thinsp;37) were female and 15.9% (n\u0026thinsp;=\u0026thinsp;7) were male, with an average age of 22.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3 years. In terms of laterality, 43.2% (n\u0026thinsp;=\u0026thinsp;19) of cases were on the right side and 56.8% (n\u0026thinsp;=\u0026thinsp;25) on the left side. The etiology was traumatic in 48.8% (n\u0026thinsp;=\u0026thinsp;21) of cases and non-traumatic in 51.2% (n\u0026thinsp;=\u0026thinsp;23). The level of activity prior to surgery was distributed as follows: 63.9% (n\u0026thinsp;=\u0026thinsp;28) inactive, 19.4% (n\u0026thinsp;=\u0026thinsp;9) moderately active, and 16.7% (n\u0026thinsp;=\u0026thinsp;7) highly active. Hyperlaxity was present in 70% (n\u0026thinsp;=\u0026thinsp;31) of cases. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFunctional results showed significant improvements in terms of preoperative and postoperative status. The average range of flexion increased from 120.48\u0026deg; preoperatively to 125.91\u0026deg; postoperatively, although this was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.11). The range of extension showed an improvement from 1.14\u0026deg; to -0.45\u0026deg;, without statistical significance (p\u0026thinsp;=\u0026thinsp;0.09).\u003c/p\u003e\u003cp\u003eFunctional scores showed a statistically significant improvement. On the Kujala scale, they improved from an average of 59.23\u0026thinsp;\u0026plusmn;\u0026thinsp;14.59 to 90.22\u0026thinsp;\u0026plusmn;\u0026thinsp;10.23 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), thus confirming our hypothesis. We also found a statistical improvement in the other scales. for example, we found an improvement on the Tegner scale from 2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27 to 4.34\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Lysholm from 52.98\u0026thinsp;\u0026plusmn;\u0026thinsp;20.40 to 88.35\u0026thinsp;\u0026plusmn;\u0026thinsp;12.26 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), subjective IKDC from 50.28\u0026thinsp;\u0026plusmn;\u0026thinsp;18.43 to 84.89\u0026thinsp;\u0026plusmn;\u0026thinsp;12.66 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and KOOS from 56.91\u0026thinsp;\u0026plusmn;\u0026thinsp;18.69 to 90.48\u0026thinsp;\u0026plusmn;\u0026thinsp;9.44 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe overall recurrence rate was 15.9% (n\u0026thinsp;=\u0026thinsp;7) at an average follow-up of 37 months (range: 5-159 months). Postoperative satisfaction levels were high, with 65.8% (n\u0026thinsp;=\u0026thinsp;29) reporting high satisfaction with the surgery performed (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Prognostic factors associated with complications included female sex, with women having a higher risk of complications than men (p\u0026thinsp;=\u0026thinsp;0.07), activity level, with complications being more common in those with no previous activity (p\u0026thinsp;=\u0026thinsp;0.02), shorter stature (p\u0026thinsp;=\u0026thinsp;0.03), lower preoperative flexion range (p\u0026thinsp;=\u0026thinsp;0.001), and lower preoperative objective IKDC score (p\u0026thinsp;=\u0026thinsp;0.04). \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePostoperative satisfaction was associated with several factors. Female patients reported lower satisfaction (p\u0026thinsp;=\u0026thinsp;0.03), as did those with a positive J sign (p\u0026thinsp;=\u0026thinsp;0.06). Weight and duration of symptoms also affected the level of satisfaction, which was lower in lighter patients (p\u0026thinsp;=\u0026thinsp;0.04) and those with longer-lasting symptoms (p\u0026thinsp;=\u0026thinsp;0.04). These results highlight the importance of considering these prognostic factors when evaluating the effectiveness and outcomes of PMFL reconstruction in patients with patellofemoral instability.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSample characteristics (n\u0026thinsp;=\u0026thinsp;44).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDetail\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (84.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (15.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSide, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (43.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSide, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (56.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEtiology, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTraumatic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (48.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEtiology, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-traumatic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (51.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActivity level, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (63.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActivity level, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActivity level, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHyperlaxity, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAll comparisons were performed using paired Student\u0026rsquo;s t-test. Reported values include the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), absolute change (Δ), t-value, corresponding F-value (calculated as t\u0026sup2;), and p-value. Associations with categorical variables, such as complications, were analyzed using chisquare or Fisher\u0026rsquo;s exact test, as appropriate.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbsolute Δ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eF-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKujala\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e59.23\u0026thinsp;\u0026plusmn;\u0026thinsp;14.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e90.22\u0026thinsp;\u0026plusmn;\u0026thinsp;10.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;30.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e133.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLysholm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e52.98\u0026thinsp;\u0026plusmn;\u0026thinsp;20.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e88.35\u0026thinsp;\u0026plusmn;\u0026thinsp;12.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;35.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e97.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTegner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4.34\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;1.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e21.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubjective IKDC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e50.28\u0026thinsp;\u0026plusmn;\u0026thinsp;18.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e84.89\u0026thinsp;\u0026plusmn;\u0026thinsp;12.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;34.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e105.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKOOS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e56.91\u0026thinsp;\u0026plusmn;\u0026thinsp;18.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e90.48\u0026thinsp;\u0026plusmn;\u0026thinsp;9.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;33.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e113.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of demographic and preoperative clinical variables between patients with and without postoperative complications. Values are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or number (percentage), as appropriate. ROM\u0026thinsp;=\u0026thinsp;range of motion; IKDC\u0026thinsp;=\u0026thinsp;International Knee Documentation Committee.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eComplication: Yes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eComplication: No\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale sex, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (80.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActivity level, n\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; 0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight (cm), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e156.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative knee flexion ROM (\u0026deg;), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100.6\u0026thinsp;\u0026plusmn;\u0026thinsp;38.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e124.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative objective IKDC, mean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.29 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.0 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, reconstruction of the medial patellofemoral ligament using an anatomical technique showed a significant improvement in knee stability and function in patients with patellofemoral instability. These findings are consistent with previous studies that have demonstrated the effectiveness of this surgical procedure. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eFor example, Zhao et al. (2021) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] reported a similar improvement in Kujala and IKDC scores in patients undergoing MPFL reconstruction. Furthermore, in the same study, more than 80% of patients returned to their daily activities and sports, which supports our positive results in these metrics. However, the complication rate in this study was 15.9%, slightly lower than that reported by various authors such as Shah et al. (2012), [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] who found a complication rate of 26.1%. This difference could be attributed to variability in the type of graft used, the surgeon's experience, the patellar and femoral fixation method, and patient selection. Although our study was based on the Mexican population, which had a higher proportion of women, who in turn showed a greater predisposition to complications, we presented a lower complication rate compared to the international literature.\u003c/p\u003e\u003cp\u003eSome authors, such as Navarini and Camp et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] found a recurrence rate of 3.2\u0026ndash;6.5%; however, these are small case series and consider more than one anatomical configuration in PMFL reconstruction.\u003c/p\u003e\u003cp\u003ePostoperative satisfaction levels in our study were generally high, although women, patients with a positive J sign, and those with patellar chondromalacia had lower satisfaction, mainly due to a feeling of instability and stiffness, which is consistent with the findings of Yacuzzi et al. (2017), [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] who also observed a high degree of satisfaction (86%) after surgery, with a very low percentage of dissatisfaction (14%) due mainly to postoperative stiffness and arthrofibrosis. The degree of satisfaction of the patients in this study may be related to residual instability and postoperative rehabilitation time.\u003c/p\u003e\u003cp\u003eOur cohort exhibited statistically significant improvements across all validated functional outcome measures. The Kujala score increased from a mean of 59.23 to 90.22, while the Lysholm score rose from 52.98 to 88.35, both indicating substantial enhancement in knee function. The Tegner activity scale improved from 2.60 to 4.34, reflecting a higher return to pre-injury activity levels. Similarly, the subjective IKDC score improved from 50.28 to 84.89, and the KOOS from 56.91 to 90.48, demonstrating broad functional recovery and reduction of symptoms. As expected and consistent with previously published literature, these findings confirm that surgical intervention resulted in clinically meaningful and sustained functional gains across all outcome instruments applied.\u003c/p\u003e\u003cp\u003eAn important limitation of our study was the lack of preoperative information. On several occasions, it was difficult to locate patients, and they did not remember the preoperative status of their knee. In addition, various surgeons with varying degrees of experience participated in this study, and it should be noted that the same graft was not used in all surgeries. All of this could influence the final functional results, recurrence rate, and degree of satisfaction with MCL reconstruction.\u003c/p\u003e\u003cp\u003eThe recurrence rate highlights the need for careful patient evaluation and selection, as well as consideration of additional surgical techniques to optimize outcomes. Compared with the existing literature, our findings are consistent, although variability in certain outcomes suggests areas for future research and improvements in clinical practice.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eAnatomical reconstruction of the PMFL improves knee stability and function in patients with patellofemoral instability, with an average Kujala score of 90.22, high patient satisfaction, and an acceptable recurrence rate of 15.9% at an average follow-up of 37 months.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman subjects:\u003c/strong\u003e Informed consent for treatment and open access publication was obtained or waived by all participants in this study. \u003cstrong\u003eAnimal subjects:\u003c/strong\u003e All authors have confirmed that this study did not involve animal subjects or tissue. \u003cstrong\u003eConflicts of interest:\u003c/strong\u003e In compliance with the ICMJE uniform disclosure form, all authors declare the following: \u003cstrong\u003ePayment/services info:\u003c/strong\u003e All authors have declared that no financial support was received from any organization for the submitted work. \u003cstrong\u003eFinancial relationships:\u003c/strong\u003e All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work\u003cstrong\u003e. Other relationships:\u003c/strong\u003e All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional research and ethics committee. Due to the retrospective nature of this manuscript, informed consent was not required from the selected patients; however, each of them had provided consent to undergo the surgical procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person’s data in any form (including images, videos, or personal details).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the conclusions of this article are available if requested.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eJasso-Campuzano S.I.: Study conception and design, surgical procedures, data collection, critical revision of the manuscript.\u003c/li\u003e\n \u003cli\u003eJiménez-Aroche C.A.: Data analysis and interpretation, drafting of the manuscript, coordination of the study.\u003c/li\u003e\n \u003cli\u003eJiménez-Castro J.R.: Patient follow-up, data collection, preparation of tables and figures.\u003c/li\u003e\n \u003cli\u003eLaffite-García H.: Statistical analysis, methodological support, manuscript editing.\u003c/li\u003e\n \u003cli\u003eVillalobos-Córdova F.E.: Critical review for important intellectual content, supervision of the project, final approval of the manuscript.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the medical staff of the Orthopaedics and Traumatology Department of our institution for their valuable support in patient care and data collection. We also acknowledge the contribution of the Biostatistics Unit for their guidance in the statistical analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information -\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAffiliations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNational Rehabilitation Institute\u003c/p\u003e\n\u003cp\u003eOrthopedic Surgery, Sports Medicine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponsal Author:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCésar A. Jiménez-Aroche MD, MS.\u003c/p\u003e\n\u003cp\u003ePhone: +52 993 264 2324\u003c/p\u003e\n\u003cp\u003ee-mail: [email protected]\u003c/p\u003e\n\u003cp\u003eCalz México-Xochimilco 289, ZP 14389\u003c/p\u003e\n\u003cp\u003eMéxico City, México.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGuill\u0026eacute;n Morales JC, Araujo Espinoza GE, Lozano Lurita C, Torres Manrique AD. Resultados funcionales en la reconstrucci\u0026oacute;n anat\u0026oacute;mica del ligamento patelofemoral medial en el tratamiento de la luxaci\u0026oacute;n patellar recurrente. Rev Soc Peru Ortop Traumatol. 2021;3:8\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHiemstra LA, Kerslake S, Lafave MR. Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 2016;24:3093\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00167-016-4346-0\u003c/span\u003e\u003cspan address=\"10.1007/s00167-016-4346-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoo JD, Huh MH, Lee CW, Roh YH, D'Lima DD, Shin YS. Medial patellofemoral ligament reconstruction appears to be a better treatment than repair, proximal realignment, or conservative management for primary patellar dislocation: A network meta- analysis. Med (Baltimore. 2023;102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000035251\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000035251\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu T, Zhu Y, Zhang L, Xie HQ, Fu W. Results of medial patellofemoral ligament reconstruction with and without tibial tubercle transfer in patellar instability: A systematic review and meta-analysis. Orthop Surg. 2023;15:2766\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/os.13870\u003c/span\u003e\u003cspan address=\"10.1111/os.13870\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao Z, Wang Y, Li J, Wang H, Bai X, Wang Q, Li Z. Clinical outcomes and prognostic factors in patients with recurrent patellar lateral dislocation treated with isolated medial patellofemoral ligament reconstruction: A retrospective single- center analysis. Orthop JSportsMed. 2021;9:2325967121995803. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2325967121995803\u003c/span\u003e\u003cspan address=\"10.1177/2325967121995803\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBartsch A, N\u0026uuml;esch C, Rieger B, M\u0026uuml;ndermann A, Egloff C. Dynamic versus static medial patellofemoral ligament reconstruction technique in the treatment of recurrent patellar dislocation: a randomized clinical trial protocol. J Orthop Surg Res. 2022;17:345. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13018-022-03158-6\u003c/span\u003e\u003cspan address=\"10.1186/s13018-022-03158-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGondolfo R Jr, Emanuele HS, Guerreiro JPF, Queiroz AO, Danieli MV. Clinical results of medial patellofemoral ligament reconstruction. Acta Ortop Bras. 2022;30(10). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/1413-785220223003e241172\u003c/span\u003e\u003cspan address=\"10.1590/1413-785220223003e241172\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMigliorini F, Trivellas A, Eschweiler J, Knobe M, Tingart M, Maffulli N. Comparable outcome for autografts and allografts in primary medial patellofemoral ligament reconstruction for patellofemoral instability: systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30:1282\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00167-021-06569-w\u003c/span\u003e\u003cspan address=\"10.1007/s00167-021-06569-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMigliorini F, Oliva F, Maffulli GD, Eschweiler J, Knobe M, Tingart M, Maffulli N. Isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability: analysis of outcomes and risk factors. J Orthop Surg Res. 2021;16:239. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13018-021-02383-9\u003c/span\u003e\u003cspan address=\"10.1186/s13018-021-02383-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32:1114\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0363546503260788\u003c/span\u003e\u003cspan address=\"10.1177/0363546503260788\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang J, Yi Z, Li J, Liu Y, Xia Y, Wu M. Medial patellofemoral ligament reconstruction is preferred to repair or reefing for first- time patellar dislocation: A systematic review and meta-analysis. Indian J Orthop. 2022;57:177\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s43465-022-00770-w\u003c/span\u003e\u003cspan address=\"10.1007/s43465-022-00770-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJos S, Shankar S, Anand R, Manathara LT, Paulose B. Outcomes of MPFL reconstruction with tibial tubercle transfer for recurrent patellar instability with high-grade trochlear dysplasia in Indian population. J Clin Orthop Trauma. 2021;20:101490. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcot.2021.101490\u003c/span\u003e\u003cspan address=\"10.1016/j.jcot.2021.101490\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHao K, Feng A, Kong L, Wang F. Quality of life following medial patellofemoral ligament reconstruction combined with medial tibial tubercle transfer in patients with recurrent patellar dislocation: a retrospective comparative study. J Orthop Surg Res. 2022;17:416. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13018-022-03310-2\u003c/span\u003e\u003cspan address=\"10.1186/s13018-022-03310-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKujala UM, Jaakkola LH, Koskinen SK, et al. Scoring of patellofemoral disorders. Arthroscopy. 1993;9(2):159\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0749-8063(05)80366-4\u003c/span\u003e\u003cspan address=\"10.1016/S0749-8063(05)80366-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10(3):150\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/036354658201000306\u003c/span\u003e\u003cspan address=\"10.1177/036354658201000306\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985, (198):43\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIrrgang JJ, Anderson AF, Boland AL, et al. Development and validation of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2001;29(5):600\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/03635465010290051301\u003c/span\u003e\u003cspan address=\"10.1177/03635465010290051301\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS). J Orthop Sports Phys Ther. 1998;28(2):8896. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2519/jospt.1998.28.2.88\u003c/span\u003e\u003cspan address=\"10.2519/jospt.1998.28.2.88\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReddy G, Hayer PS, UlIslam S, Mehta NJ, Iqbal HJ, Stables G, Barton-Hanson NG. Outcomes of allograft medial patellofemoral ligament reconstruction in children and adolescents with hypermobility. Int J Appl Basic Med Res. 2022;12:161\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijabmr.ijabmr_25_22\u003c/span\u003e\u003cspan address=\"10.4103/ijabmr.ijabmr_25_22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRomo-Rivera J, Rangel-P\u0026eacute;rez LJ. Reconstrucci\u0026oacute;n del ligamento patellofemoral medial con autoinjerto de tend\u0026oacute;n cuadricipital. Acta Ortop Mex. 2021;35:425\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.35366/104569\u003c/span\u003e\u003cspan address=\"10.35366/104569\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2012;40:1916\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0363546512442330\u003c/span\u003e\u003cspan address=\"10.1177/0363546512442330\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavarini JP, Maestu R, Batista JP, Ocampo M, Ciliberto F, Rainaudi P. Reconstrucci\u0026oacute;n de ligamento patelofemoral medial. Artroscopia. 2013;20:90\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCamp CL, Krych AJ, Dahm DL, Levy BA, Stuart MJ. Medial patellofemoral ligament repair for recurrent patellar dislocation. Am J Sports Med. 2010;38:2248\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0363546510378053\u003c/span\u003e\u003cspan address=\"10.1177/0363546510378053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYacuzzi C, Palacios J, Zicaro JP, O\u0026ntilde;ativia I, Costa Paz M. Reconstrucci\u0026oacute;n de Ligamento Patelofemoral Medial. Evaluaci\u0026oacute;n de resultados cl\u0026iacute;nicos a 3 a\u0026ntilde;os de seguimiento. Artroscopia. 2017;24:65\u0026ndash;708.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Recurrence, functional results, anatomical reconstruction, mpfl, medial patellofemoral ligament, patellofemoral instability","lastPublishedDoi":"10.21203/rs.3.rs-7584490/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7584490/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate functional outcomes, recurrence rates, and satisfaction in patients undergoing anatomical reconstruction of the MPFL.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eLongitudinal observational study of 44 patients operated on between January 2010 and January 2024. Demographic and clinical variables were recorded; pre- and postoperative Kujala, Lysholm, Tegner, IKDC, and KOOS scales; ranges of motion; recurrence; and satisfaction. Analysis with paired/independent Student's t-test and chi-square/Fisher (p\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSignificant improvement in all scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Recurrence rate 15.9% (n\u0026thinsp;=\u0026thinsp;7) at 37.2 months of follow-up. High satisfaction in 65.8% (n\u0026thinsp;=\u0026thinsp;29). Factors associated with complications: shorter stature, lower preoperative flexion, low target IKDC, and absence of previous activity.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAnatomical reconstruction of the MPFL offers favorable functional results and low recurrence in the Mexican population.\u003c/p\u003e\u003ch2\u003eLevel of Evidence\u003c/h2\u003e\u003cp\u003eIV.\u003c/p\u003e","manuscriptTitle":"Anatomical Reconstruction of The Medial Patellofemoral Ligament for Recurrent Patellar Dislocation: Functional Evaluation and Follow-Up Analysis.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-13 07:41:05","doi":"10.21203/rs.3.rs-7584490/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5e497bc-4434-4cc7-8bab-3ee1eb2ccf08","owner":[],"postedDate":"November 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-13T07:41:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-13 07:41:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7584490","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7584490","identity":"rs-7584490","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}