Surgical precision matters: Straying from a key landmark raises MPFL reconstruction failure risk

A study presented at the American Orthopaedic Society for Sports Medicine Annual Meeting found that deviation from Schöttle's point — a key anatomical landmark on the femur — during MPFL reconstruction is linked to higher graft failure rates. The procedure, used to treat patellofemoral instability, generally has a low failure rate, but precision in femoral tunnel placement appears to be a critical success factor.

Researchers conducted a single-center, propensity-matched cohort study of 132 patients (44 failed, 88 successful) who underwent primary MPFL reconstruction between 2010 and 2024. Beyond tunnel placement, fixation technique and graft type also emerged as important variables.

Key Takeaways:

• Patients in the failed group had a higher rate of skeletal immaturity (43.2% vs. 21.6%)
• 100% of non-failed surgeries used allograft, vs. only 61% in the failed group
• Failed reconstructions more often used patellar inlay fixation (48% vs. 18%) and less often femoral inlay fixation (76% vs. 94%)

Why it matters: These findings reinforce the importance of anatomical precision and thoughtful technique selection in MPFL reconstruction, particularly in younger patients with skeletal immaturity. Researchers are calling for prospective studies to further clarify the role of fixation strategy.