Medial Retinacular Plication/Reefing/Repair

MRP was performed in different patients by each of the 5 different surgeons, with some inherent variation in technique. Terms utilized variably and interchangeably to describe this technique included medial retinacular or MPFL “plication,” “imbrication,” “repair,” “shortening,” and “tightening.” Common to all was reconfiguration of native medial retinacular or MPFL tissue for an effective shortening of the length of the MPFL and the absence of any graft material. Common steps included a 2- to 3-cm skin incision and dissection through the subcutaneous layer and through layer 1 to expose the retinacular/MPFL layer (layer 2). In most instances, plication of retinacular tissue was performed with figure-of-8 high-strength braided sutures placed over a segment of tissue spanning 1.5 to 3 cm in width (from the medial border of the patella, lateral to the mid-MPFL region) and 1.5 to 3 cm in length (from the level of the superior pole of the patella to the inferior quartile of the patella). In some instances, a similar elliptical-shaped segment of retinacular tissue was excised, allowing for side-to-side closure of this layer, and in other instances, 2 double-loaded suture anchors were placed into the patella along the medial border (at approximately three-fourths height and half height), and simple or horizontal mattress sutures were placed into the medial retinaculum 1.5 to 3 cm from the medial border. In all variations of the above techniques, the knee range of motion and dynamic patellar stability were checked after the plication, with subsequent modifications made, as needed, to the tension of the repair.