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Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique.

ABSTRACT: Medial patellofemoral ligament (MPFL) reconstruction is a common procedure used to treat both acute and chronic patellar instability. Although many variations of MPFL reconstruction have been described, there is no consensus regarding the optimal surgical technique. We describe a technique for MPFL reconstruction with a looped gracilis tendon autograft using suture anchors to secure the graft to the patella and a suspensory loop button system for fixation to the femur. This technique replicates the native shape of the MPFL while minimizing the risk of patellar fracture and allowing for gradual tensioning of the graft.

SUBMITTER: Godin JA

PROVIDER: S-EPMC4722431 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique.

Godin Jonathan A JA Karas Vasili V Visgauss Julia D JD Garrett William E WE

Arthroscopy techniques 20151026 5

Medial patellofemoral ligament (MPFL) reconstruction is a common procedure used to treat both acute and chronic patellar instability. Although many variations of MPFL reconstruction have been described, there is no consensus regarding the optimal surgical technique. We describe a technique for MPFL reconstruction with a looped gracilis tendon autograft using suture anchors to secure the graft to the patella and a suspensory loop button system for fixation to the femur. This technique replicates ...[more]

PMID: 26900561

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Medial patellofemoral ligament reconstruction procedure using a suspensory femoral fixation system.

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Combined Reconstruction of the Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament.

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Project description:The medial patellofemoral ligament (MPFL), which is critical for both patellar stability and normal kinematics of the patellofemoral joint, is disrupted in most patellar dislocations. Consequently, MPFL reconstruction is advocated in recurrent dislocations to restore native patellar constraints. Fixation of the MPFL graft to the medial border of the patella can be achieved through various methods, each with its own benefits and drawbacks. We present a technique for MPFL fixation to the patella using all-soft suture anchors, theoretically decreasing the risk of patellar fracture and articular surface violation.

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Soft-Tissue Loop for Medial Patellofemoral Ligament Reconstruction.

Project description:A patient with patellar instability frequently presents with anterior knee pain, patellar subluxation, or dislocation. Medial patellofemoral ligament (MPFL) has a key role for normal patella tracking and stability. Reconstruction of the MPFL using a hamstring graft is a commonly used procedure for the treatment of chronic lateral subluxation of patella. Anchor sutures and bony tunnels are used for the patellar attachment of the graft. This can be associated with complications such as patella fracture; besides, it does not produce an anatomical reconstruction for the native MPFL that can alter the direction of tension applied on the patella. To overcome these problems, a soft-tissue loop technique is used for MPFL reconstruction. During this procedure, a semitendinosus graft was passed through the prepatellar extensor retinaculum and secured with sutures. The free ends of the graft were then passed between the second and third layers of the medial patellofemoral retinaculum and fixed to a femoral tunnel on the medial femoral condyle with an interference screw. The desired amount of tension on the graft is achieved under direct vision of patella tracking arthroscopically. We found this method to be relatively safe and fast. It is more anatomical and can avoid the complications during the conventional bony procedures.

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Medial patellofemoral ligament reconstruction: a new technique for graft fixation at the patella without implants.

Project description:Patellofemoral instability is a complex disorder that is often accompanied by insufficiency or tearing of the medial patellofemoral ligament. Over the past few years, several techniques using free tendon grafts for medial patellofemoral ligament reconstruction have become popular because of their reproducible effect and good outcome. Whereas most surgeons prefer femoral fixation of the graft using an interference screw, the possibilities of patellar fixation are numerous. All of the different techniques have their own advantages and pitfalls. We describe a technique in which we drill 2 blind-ending tunnels (1 cm) at the medial aspect of the patella, where the doubled graft (not the free ends) is pulled in and fixed. By using a special technique for shuttling the sutures, there is no need for an additional skin incision and no need for implants, allowing very secure graft fixation without a relevant risk of fracture.

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Medial Collateral Ligament Reconstruction With Dual Adjustable-Loop Suspensory Fixation: A Technique Guide.

Project description:The purpose of this technique paper is to outline a minimally invasive technique using dual suspensory fixation with adjustable-loop devices for reconstruction of the superficial medial collateral ligament. The femoral fixation is performed through a limited approach at the anatomic origin of the medial collateral ligament, a socket is prepared, and the graft is docked using the adjustable-loop suspensory fixation. The tibial socket is prepared through a separate incision just distal to the pes anserine tendons and drilled medially to laterally perpendicular to the tibial shaft. The graft is tunneled and docked into the tibial tunnel using adjustable-loop cortical suspensory fixation on the far cortex. The knee is cycled through a full arc of motion and stressed in valgus to take initial creep out of the construct. The knee is placed in 30° of flexion and slight varus and final tension is applied to both the femoral and tibial side. With this technique, fixation can be completed with a minimally invasive incision and it allows the ability to tension the graft both on the femoral and tibial side to the desired level, providing a significant advantage over previously used interference screw techniques.

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