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Combined Medial Patellofemoral Ligament, Medial Quadriceps Tendon-Femoral Ligament, and Medial Patellotibial Ligament Reconstruction for Patellar Instability: A Technical Note.

ABSTRACT: Lateral patellar dislocations often occur in a young, athletic population of recurrent dislocators with generalized laxity and an interest in returning to an active lifestyle. A recent appreciation for the distal patellotibial complex has directed surgeons toward attempting to re-create the native anatomy and knee biomechanics during medial patellar reconstructive procedures. By reconstructing the medial patellotibial ligament (MPTL) in addition to the medial patella-femoral ligament (MPFL) and medial quadriceps tendon-femoral ligament (MQTFL), the current article describes a potentially more stable construct that can be utilized in patients with subluxation with the knee in full extension, patellar instability with the knee in deep flexion, genu recurvatum, and generalized hyperlaxity. Additionally, the current technique utilizes a tibialis anterior allograft. The purpose of this Technical Note is to describe, in detail, the current authors' technique for a combined MPFL, MQTFL, and MPTL reconstruction.

SUBMITTER: Hinckel BB

PROVIDER: S-EPMC10066251 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Combined Medial Patellofemoral Ligament, Medial Quadriceps Tendon-Femoral Ligament, and Medial Patellotibial Ligament Reconstruction for Patellar Instability: A Technical Note.

Hinckel Betina B BB Dean Robert S RS Ahlgren Conner D CD Cavinatto Leonardo M LM

Arthroscopy techniques 20230208 3

Lateral patellar dislocations often occur in a young, athletic population of recurrent dislocators with generalized laxity and an interest in returning to an active lifestyle. A recent appreciation for the distal patellotibial complex has directed surgeons toward attempting to re-create the native anatomy and knee biomechanics during medial patellar reconstructive procedures. By reconstructing the medial patellotibial ligament (MPTL) in addition to the medial patella-femoral ligament (MPFL) and ...[more]

PMID: 37013008

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Project description:Recent studies on the detailed anatomy of the medial patellar stabilizer have revealed that the medial patellofemoral ligament (MPFL) not only attaches to the patella but also has fibers that attach to the quadriceps muscle, known as the medial quadriceps tendon femoral ligament (MQTFL). Reconstruction of the medial stabilizer for patellar dislocation that includes both the MPFL and MQTFL may achieve better anatomical and physiological correction. In this Technical Note, we will describe a simultaneous reconstruction technique of the MPFL and MQTFL for patellar dislocation using an artificial ligament. Technique Video Video 1 A simultaneous MPFL and MQTFL reconstruction using an artificial ligament for lateral patella instability of the left knee. The first step is to create an L-shaped patellar bone tunnel to pass through the MPFL graft. The medial aspect of the patella is exposed, and the L-shaped bone tunnel at the proximal third of the patella is created with a cannulated drill. Then, an artificial ligament (Leeds-Keio 20) is passed. The second step is to pass the MQTFL graft through the split rectus femoris. After the split is made with a sharp pointed scalpel in the middle of the rectus femoris, a curved mosquito forceps is inserted and passed between the rectus femoris and the vastus intermedius tendon, and the tip of the mosquito forceps is brought out to the medial edge of the rectus femoris tendon. An artificial ligament (Leeds-Keio 15) is clamped and folded back through the split tendon to form a loop. The final step is to create the femoral tunnel and fix the MPFL and MQTFL graft. A skin incision is made, and a guide pin is inserted at the femoral attachment of the MPFL under fluoroscopy. The artificial ligament is passed between the deep facia and the capsule of the knee joint to exit through the second incision. Then, the artificial ligament is folded over the guide pin and temporarily fixed with a pair of Kocher forceps. The stability of the patella and the tension of the artificial ligament are checked. The tension of the artificial ligament should not be excessive in knee flexion. After determining the suitable length, the position where the artificial ligament enters the femoral tunnel is marked. The section entering the bone tunnel from the marked area is cylindrically bound together with absorbable sutures, the ligament extending beyond the mark is cut off, and the tip of the remaining section is attached to a guide suture. After creating a femoral tunnel with a cannulated drill, an artificial ligament is placed using a guide suture into the bone tunnel until reaching the marked area. The artificial ligament is checked again for tension, and the artificial ligament is fixed with an interference screw. A final check is performed to ensure the stability of the patella, and the wound is closed. (MPFL, medial patellofemoral ligament; MQTFL, medial quadriceps tendon femoral ligament.)

Dataset Information

Combined Medial Patellofemoral Ligament, Medial Quadriceps Tendon-Femoral Ligament, and Medial Patellotibial Ligament Reconstruction for Patellar Instability: A Technical Note.

Publications

Combined Medial Patellofemoral Ligament, Medial Quadriceps Tendon-Femoral Ligament, and Medial Patellotibial Ligament Reconstruction for Patellar Instability: A Technical Note.

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