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Complex patellofemoral reconstruction was defined as medial patellofemoral ligament reconstruction (MPFL\u2010R) combined with at least one major bony procedure (distal femoral osteotomy, high tibial osteotomy, and trochleoplasty). Outcome was evaluated retrospectively after a minimum follow\u2010up of 12\u00a0months using Tegner activity scale, Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0), EuroQol\u20105D\u20103L (EQ\u20105D\u20103L), EuroQol Visual analog scale (EQ\u2010VAS), and a questionnaire about sexual activity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 34 females (mean age, 26\u2009\u00b1\u20095 years) with a mean follow\u2010up of 45\u2009\u00b1\u200916\u00a0months were included. Seventy\u2010seven percent had one major bony correction\u2009+\u2009MPFL\u2010R and 24% had at least two major bony corrections\u2009+\u2009MPFL\u2010R. The re\u2010dislocation rate was 6%. Median Tegner activity scale improved from 3 (range 0\u201310) to 4 (range 2\u20136) (n.s.) and an improved activity level was observed in 49% of subjects. QoL scores showed an EQ\u20105D\u20103L Index Value of 0.89\u2009\u00b1\u20090.15, EQ\u2010VAS of 80.3\u2009\u00b1\u200911.4, and BPII of 68.3\u2009\u00b1\u200919.1. Thirty\u2010four percent of patients reported restrictions of sexual activities due to PFI preoperatively with an improved sexual function observed in 60% postoperatively due to less pain, improved mobility, and less apprehension. Postoperative return to sexual activity was 91%, whereof 19% reported current restrictions of sexual function because of pain and\/or limited range of motion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite the complexity and invasiveness of complex patellofemoral reconstruction, combined bony procedures and MPFL\u2010R resulted in a low redislocation rate, improved physical activity and QoL comparable to values reported after isolated MPFL\u2010R. Furthermore, sexual activity was improved in 60% of females with preoperative restrictions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06340-7","type":"journal-article","created":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T12:05:08Z","timestamp":1603973108000},"page":"3017-3024","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Complex patellofemoral reconstruction leads to improved physical and sexual activity in female patients suffering from chronic patellofemoral instability"],"prefix":"10.1002","volume":"29","author":[{"given":"Patricia M.","family":"Lutz","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department for Orthopedic Sports Medicine Technical University Munich Ismaninger Str. 22 81675 Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp 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Imhoff is a consultant for Arthrosurface and Medi Bayreuth and receives royalties from Arthrex and Arthrosurface. All other authors declare that they have no conflict of interest related to this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval was obtained from the Ethics Committee of the technical University Munich. The study was approved by the institutional review board of the Technical University of Munich (575\/19 S). 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