A “sandwich” method of reconstruction of the medial patellofemoral ligament using a titanium interference screw for patellar instability in skeletally immature patients (original) (raw)
Related papers
Knee Surgery, Sports Traumatology, Arthroscopy, 2011
Purpose The importance of the medial patello-femoral (MPFL) and medial patello-tibial ligaments (MPTL) to the stability of the patella is undoubted. The purpose of this work was to present a technique for the reconstruction of both ligaments and prospectively record its outcome. Methods Cadaveric part: the MPFL and MPTL were identified in five knee specimens. Sequential cutting and reattaching of these ligaments were performed to study their effect on patellar stability. Clinical part In the years between 2005 and 2008, twenty-five knees in twenty-one patients had reconstruction of their MPFL and MPTL using the semitendinosus tendon. In eight of these knees, ligament reconstruction was combined with tibial tubercle osteotomy. The IKDC and Insall's classification of outcome were used for the evaluation of all knees. Results Cadaveric study revealed that resecting the MPTL increased the lateral translation of the patella up to subluxation at full extension. Intact MPFL avoids full dislocation. Regarding the clinical study, at a minimum 24-months follow-up, all patients reported to have stable patello-femoral joints. There was a significant improvement of the IKDC score 54 ± 2 pre-operatively to 81 ± 2 (Mean ± SD) at 24 months post-operative (P \ 0.0003). Nineteen knees scored excellent, five were good and one had fair result. Conclusion A technique for the reconstruction of the MPFL and MPTL that can be performed through minimally invasive approach has been presented and shown to be successful in restoring knee function in cases of traumatic and recurrent patellar dislocation. Level of evidence III.
International Journal of Research in Orthopaedics, 2021
The purpose of this study was to present new surgical technique for MPFL reconstruction. We also describe its functional outcome, complications, and the advantages of the procedure. This study is a prospective analysis of collected data during the period of august 2018 to January 2020. Ten cases of patients with recurrent symptomatic patellar instability and who underwent isolated MPFL reconstruction were included in the study. Kujala scoring and lysholm scoring was done to assess the functional outcome at follow-up. Post-operative dislocation and apprehension were recorded in each case along with any complication. Pre-operative Kujala score was 36.80 which improved to 89.80 postoperatively at the time follow-up. Pre-operative lysholm score was 36.80 which improved to 92.70 postoperatively at the time follow-up. The improvement in Kujala score and Lysholm score was found to be highly significant (p<0.01). We have done a simple technique where MPFL is reconstructed anatomically to...
Medial Patellofemoral Ligament Reconstruction-State of the Art
The management of recurrent patellar instability has undergone progressive changes over the past few decades with improved optimal and predictable outcomes for the patients. Open surgical realignment procedures with bony osteotomies either proximal or distal to the Patella, designed to correct the imbalance of the extensor mechanism such that the patella tracks smoothly over the trochlea were commonly advocated. These procedures aimed to restore normal chondral loading of the patellofemoral joint and modify or delay progression of arthritic changes at an early age. With enhanced knowledge on the biomechanics of the anatomical structures providing medial and lateral restraints around the knee, the role of the Medial Patello-Femoral Ligament has been shown to be a vital one. This has refined the surgical options available to minimally invasive arthroscopic approaches with satisfying calculable results. This review article outlines the evolution of the surgical management of patellar instability and the prominent role of the MPFL reconstruction in achieving it. The biomechanics, surgical principles, anatomic landmarks, types of grafts and fixation methods, along with the senior surgeon's preferred surgical technique are described in detail.
Joints
Medial patellofemoral ligament (MPFL) represents the main restraint against lateral patellar displacement. The MPFL insertion at the patella is up to 30 mm wide and is located along the upper half of the medial patellar rim. The femoral insertion of the MPFL is approximately 10 mm distal to the apex of the adductor tubercle and 16 mm proximal to the medial epicondyle. Since most of the patients suffer from MPFL rupture just after the first patellar dislocation, MPFL reconstruction results necessarily in all cases of chronic objective patellar instability to reestablish the primary passive patellofemoral stabilizer. Over time, different techniques of MPFL reconstruction have been proposed with promising results in terms of patient satisfaction and redislocation rate. However, each of these techniques may present peculiar problems and/or complications. An anatomic double-bundle MPFL reconstruction through an aperture fixation both at the femur and at the patella is here presented. The...
A review of functional anatomy and surgical reconstruction of medial patellofemoral ligament
Journal of Arthroscopy and Joint Surgery, 2014
Background: Recurrent patella dislocation is a very disabling condition. The stability of patellofemoral joint depends on many general and local factors. It is believed that the Medial Patellofemoral Ligament (MPFL) is one of the major stabilisers of the patellofemoral joint in early knee flexion. Injury to the MPFL occurs in almost every patellar dislocation. This result in a significant increase in lateral patellofemoral joint tracking and contact pressures, which may affect long-term articular cartilage health. Therefore, in recent years MPFL reconstruction has become a popular surgical option in the treatment of patella instability. However there is still a growing debate regarding the correct surgical technique and post-operative rehabilitation. In addition, the long-term effect of MPFL reconstruction procedure on the patellofemoral joint is unknown. Recent research has emphasised the importance of anatomic femoral tunnel placement with the help of intraoperative radiograph. Mal-positioned femoral tunnels and over tensioned grafts during MPFL reconstruction have been reported to result in adverse outcomes such as joint stiffness, pain, recurrent instability and possibly early degenerative joint changes. Aim: To review of our current knowledge of the anatomy, function and the surgical reconstruction of MPFL Methods: We conducted cadaveric dissection to understand the anatomy of MPFL, its femoral and patellar attachments and its role in the functional stability of the patellofemoral joint. We also describe the surgical reconstruction of the MPFL using hamstring tendons, technique and accurate placements of femoral tunnel. Results: Our findings showed that the MPFL insert in an area midway between the adductor tubercle and medial epicondyle of the femur, dorsal to an extended line from the posterior cortex of the femur and attaches to the superomedial portion of the patella, and under the surface of the Vastus Medialis Obliquus tendon (VMO). The ideal graft for reconstruction is the gracilis tendon. The femoral tunnel entry point is behind the posterior cortex of the femur and above the Blumensaat's line. Conclusion: We conclude that anatomic femoral attachment and minimal tension during reconstruction of MPFL is essential for a successful outcome.
Medial Patellofemoral Ligament Reconstruction
Video Journal of Sports Medicine, 2021
Background: Patellar instability is a relatively common condition in the young, active population and causes disruption of the medial patellofemoral ligament (MPFL). MPFL reconstruction is often performed to restore this medial stabilizer and reduce the risk of recurrent instability. Indications: Isolated MPFL reconstruction has been shown to reduce the risk of recurrent patellar dislocation. It is indicated in our patients who have had more than 1 dislocation in the absence of other significant bony malalignment or cartilage defects that require concurrent surgery. Technique Description: Diagnostic arthroscopy is first performed to evaluate the patellar and trochlear cartilage surfaces. A medial approach to the patella is then performed and the 2 free limbs of the allograft are secured to the patella at the 9 to 11 (or 1 to 3) o’clock position. A small approach to the femoral insertion site of the MPFL is performed and confirmed with fluoroscopy, and the graft is secured to the fem...
Medial Patellofemoral Ligament Reconstruction: A Novel Technique Using the Patellar Ligament
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2007
In patients with chronic patellofemoral instability, more than 2 episodes of dislocation, and an anterior tuberosity trochlear groove of less than 20 mm as measured on computed tomography or nuclear magnetic resonance imaging, we have developed a technique for medial patellofemoral ligament reconstruction that uses a medial strip of the patellar ligament (PL). The incision started proximally at the level
Acta orthopaedica Belgica
Complications and results of medial patellofemoral ligament (MPFL) reconstruction, performed between 2000 and 2003, were studied retrospectively in 24 randomised patients (24 knees). All procedures were performed for recurrent dislocation or subluxation of the patella, using an autogenous semitendinosus tendon. Two different methods of anchoring of the transplant were compared. After a 2-year follow-up, patellar stability was found to be similar, when the transplant was sutured to the fibrous tissue and periosteum overlying the patella or when it was fixed in a bone tunnel through the patella. The majority of the patients who had undergone MPFL reconstruction have returned to their previous level of sports activities. We had two cases of patella fracture and one case of persisting patella apprehension after surgery. Further studies must determine which measures are necessary to prevent these complications.