Femoral fixation in MPFL reconstruction: tunnel or adductor sling?
Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine · 20 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
MPFL reconstruction is the main soft-tissue operation for recurrent lateral patellar instability, and the choice between a tunnel and a bone-sparing sling for femoral fixation is a common, practical decision for sports surgeons.
The evidence
This retrospective study from three Chilean centres compared two ways of fixing the femoral end of a medial patellofemoral ligament (MPFL) reconstruction for recurrent kneecap dislocation in 78 skeletally mature patients (84 knees): looping the graft around the adductor tendon (adductor sling, 19 knees) or fixing it in a bone tunnel at the anatomic footprint (65 knees). Final Kujala scores were high in both groups (median 91 vs 94), and the median difference of 3 points favouring the tunnel was not statistically significant (95% CI about -8.5 to 2.5). Redislocation was rare (0/18 vs 2/62). Patient-reported residual instability was numerically more common after the sling (33% vs 21%), but this estimate was imprecise.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Retrospective cohortDesign starting point: 29.6
Raised the score
- Compared against current standard of care+3.4
- Aligned time zero+2.5
Lowered the score
No negative adjustments recorded.
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerCalculation absent
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 29.6
- Aligned time zero
- +2.5
- Compared against current standard of care
- +3.4
- Journal prior (not an observed method)
- +1.2
- Final rigour score rounded
- 37 / 100
Study design sets the starting point and a ceiling of 72. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Given that patient-reported instability was numerically more common after adductor sling fixation, in which patients (for example, those with high TT-TG distance, patella alta, or higher activity demands) would you favour anatomic tunnel fixation?
2.How would you counsel a young patient with recurrent patellar dislocation about the difference between feeling unstable and actually redislocating after MPFL reconstruction, and how should that shape follow-up?
Original publication title
Adductor sling and anatomic femoral tunnel fixation both yield high postoperative functional scores after medial patellofemoral ligament reconstruction: A retrospective multicenter study