Patellar Stabilization (Anatomic MPFL Tunnelless Reconstruction) is a technique developed by Dr. Chudik that reconstructs the medial patellofemoral ligament without drilling bone tunnels or cutting bone, preserving the patient’s native anatomy. The procedure addresses recurrent patellar dislocations where conventional techniques alter the joint’s normal anatomy and predictably increase the risk of arthritis. Dr. Chudik’s approach restores the torn ligament arthroscopically while leaving the underlying bones intact.
What Is Anatomic Tunnelless MPFL Reconstruction?
The medial patellofemoral ligament (MPFL) is the primary soft-tissue restraint preventing the kneecap (patella) from dislocating laterally. When someone dislocates the patella, the structures on the medial side, including the MPFL, are torn.
After a first dislocation, many patients can rehabilitate with physical therapy and return to activities without recurrent dislocations. Some patients continue to experience instability and recurrent dislocations despite rehabilitation. With each additional dislocation, there is risk for associated cartilage injury inside the knee. After conservative treatment fails, surgery to reconstruct the MPFL is recommended.
A wide variety of MPFL reconstruction techniques exist. Many are involved procedures that drill tunnels through the patella, drill tunnels in the femur, or cut bones to realign the way the patella tracks along the femur. These approaches alter normal anatomy and predictably increase the risk of developing arthritis in the patellofemoral joint over time.
Dr. Chudik developed the anatomic tunnelless MPFL reconstruction to preserve normal anatomy. The reconstruction uses a tendon graft (typically hamstring tendon from the same knee) to create a new MPFL. The graft is secured to the femur and the patella with small anchors, without drilling tunnels through the bone or cutting bone to realign tracking.
Development Rationale
Conventional MPFL reconstruction techniques have several limitations:
- Patellar tunnels carry a small but real risk of patellar fracture during surgery or during postoperative loading
- Patellar tunnels remove bone that may be needed for future revision surgery
- Bone-cutting procedures (tibial tubercle osteotomy, trochleoplasty) alter the joint’s mechanics permanently
- Altered patellar tracking after bone-cutting procedures has been associated with higher rates of patellofemoral arthritis over time
- Hardware in the patella can be palpable and uncomfortable
Dr. Chudik developed the tunnelless technique to:
- Preserve patellar bone stock by avoiding tunnels through the patella
- Reduce the risk of patellar fracture associated with conventional tunneled techniques
- Preserve the joint’s native anatomy rather than altering it
- Keep future revision options open if the reconstruction ever needs to be revised
- Minimize hardware burden
The procedure is preferred for patients with recurrent patellar dislocations who do not have major underlying anatomic deformity. When significant trochlear dysplasia, patella alta, or elevated tibial tubercle to trochlear groove distance is present, additional anatomy-correcting procedures may be required, but Dr. Chudik prioritizes the soft-tissue reconstruction first whenever possible.
Who Is a Candidate?
Candidates typically have:
- Recurrent patellar dislocations after failed conservative treatment and physical therapy
- An active patient willing to commit to the postoperative rehabilitation program
- A knee without severe patellofemoral arthritis
Persons unwilling or unable to complete postoperative rehabilitation should not have surgery. Active or prior knee infection is a concern but not an absolute contraindication. Severe knee or patellofemoral arthritis is a contraindication.
How the Procedure Is Performed
The procedure is performed as outpatient surgery under general anesthesia with an adductor canal nerve block. A hamstring tendon graft is harvested from the same knee for the reconstruction.
The femoral attachment site of the MPFL is identified at the medial femoral epicondyle. The graft is secured at this anatomic origin with a small bone anchor. The patellar attachment is identified along the medial border of the patella. Rather than drilling tunnels through the patella to anchor the graft, Dr. Chudik secures the graft to the medial border of the patella using small bone anchors that do not require drilling across the bone. The graft is tensioned to restore normal patellar tracking without over-constraining the joint.
The reconstruction creates a new MPFL with anatomic origins, anatomic insertion, and anatomic tension, all without drilling tunnels or cutting bone.
Recovery and Rehabilitation
Recovery follows a protected protocol:
- Crutches for comfort and weight-bearing as tolerated
- Wound care: clean and dry for the first 10 to 14 days; light showering after two weeks; no submersion under water for three weeks
- Driving typically resumes at six weeks if the right lower extremity is involved
- Return to school or sedentary work in less than one week as long as the leg can be elevated
- Physical therapy to restore motion, strength, and proprioception for up to four to six months
- Quadriceps muscle preserving exercises must begin immediately after surgery
After full rehabilitation, Dr. Chudik’s Knee Return to Sport Testing confirms rehabilitation is complete and identifies any errors in movement patterns that put patients at risk for re-injury. Movement patterns are corrected before return to sport.
Return to minimal daily walking is allowed at four to six weeks after surgery. Return to running is typically four to six months post-op. Return to sport is typically four to six months post-op.
Risks and Outcomes
Specific surgical risks include:
- Infection or nerve injury (numbness) of the knee, leg, and foot
- Swelling or continued pain
- Re-injury of the reconstruction with recurrent patellar dislocation
- Knee stiffness or muscle weakness
- Recurrent dislocation or subluxation of the patella
- Clot in the veins of the calf or thigh, rarely with pulmonary embolus
Outcomes for the tunnelless technique compare favorably with conventional tunneled techniques. The risk of patellar fracture is reduced because the patella is not weakened by drilling. Patellar bone stock is preserved for any future surgery. Recurrence rates are low when patient selection is appropriate and the underlying anatomy does not include severe deformity that requires bone-cutting procedures.
Why Dr. Chudik for Anatomic Tunnelless MPFL Reconstruction
Dr. Chudik developed the tunnelless anatomic MPFL reconstruction technique. The approach reflects his preference for preserving native anatomy rather than altering it surgically, particularly in younger patients where long-term joint preservation matters most. For patients with recurrent patellar dislocations who would otherwise face conventional tunneled or bone-cutting reconstructions, the tunnelless technique offers a less destructive path to stability with comparable outcomes and preserved future surgical options.