Medial reefing

Written by Dr Sheila Strover on March 14, 2025

Medial reefing is a surgical procedure to tighten the tissues on the medial aspect of the patella. It is being used less and less as studies show it is not very effective.

Illustration to show how the patella is supported within its underlying groove by a network of retinacular tissue.
The patella is normally tethered to the surrounding tissues by the strong strands of retinaculum.
retinaculum6
If this area is torn, and the patella becomes unstable, it can be repaired by medial reefing (or the newer procedure of 'MPFL-R')...

Medial reefing seldom done nowadays

The medial reefing procedure tightens up the superficial layers on the medial side of the patella to try to better align the patella in its underlying groove.

Medial reefing also counters any excessive patellar instability that may have resulted from a prior lateral release.

But this surgical procedure has not proven very effective and is being replaced with medial patellofemoral ligament reconstruction (MPFL-R).

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Relationship of medial reefing to lateral release

Medial reefing has often been performed in association with lateral release or lateral retinacular lengthening in patients who have problems with instability of the patella.

Because lateral release surgery has in the last two decades fallen out of favour, medial reefing is no longer that commonly performed.

"Taking into consideration the negative impact on patella stability and the poor clinical results of isolated lateral release, we believe that the combined arthroscopic procedure [of medial reefing and lateral release] should no longer have a place in the management of patients with chronic patellofemoral instability."

Dominik Schorn et al

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Why MPFL reconstruction is nowadays preferred to medial reefing

MPFL reconstruction (MPFL-R) may be done after a patellar dislocation event has torn the medial patellofemoral ligament.

The procedure uses a harvested ligament and bone tunnels in both patella and femur. It gives a strong reconstruction but is quite invasive. Medial reefing, in contrast, tightens up the soft tissues in the same area without using bone tunnels.

The available evidence demonstrated that MPFL reconstruction could achieve significantly lower redislocation rate and reoperation rate than MPFL repair and medial reefing after first-time patella dislocation.

Jin Jiang et al

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A-Z Keywords -

MPFL, Medial patello-femoral ligament, MPFL reconstruction, Lateral release, Lateral retinacular lengthening, Maltracking

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Journal Interpretations -

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