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Anatomical Double-Bundle Medial Patellofemoral Ligament Reconstruction With Autologous Semitendinosus, a Single Patellar Tunnel Technique.

ABSTRACT: Patellofemoral instability is one of the knee problems that can be found in up to 3% of knee injuries, especially in younger aged females. Recent biomechanical studies showed that the main soft tissue stabilizer for patellofemoral stability is the medial patellofemoral ligament (MPFL). More than 200 articles on MPFL reconstruction have been published. Some surgical techniques create multiple holes in the patellar area that may increase the risk of patellar fractures. This technique that we present here attempts to reduce the chance of patella-related complications, while maintaining stability of the reconstructed construct, reducing the use of a lengthy tendon graft within the patella and covering the footprint at the border of the patella closed to the native anatomy of the MPFL.

SUBMITTER: Manop P

PROVIDER: S-EPMC8719305 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Double-bundle medial patellofemoral ligament reconstruction with a single patellar tunnel.

Project description:Medial patellofemoral ligament (MPFL) reconstruction is an established method to prevent patellofemoral instability. Nevertheless, the anatomy and the biomechanical behavior of native MPFL are still under investigation, but in recent years they have become more defined. We propose a technique for MPFL reconstruction based on the results of recent anatomic studies regarding the patellar insertion of the MPFL. A double-bundle MPFL is reconstructed by use of the semitendinosus tendon passed through a single patellar tunnel, which crosses the patella from the midpoint of its medial border until its superolateral corner is reached. This method permits a strong patellar fixation, potentially reducing the risk of patellar fracture compared with double-patellar tunnel techniques. Moreover, it requires no fixation devices at the patella and only a single interference screw on the femoral side.

| S-EPMC3882706 | biostudies-literature

Medial patellofemoral ligament reconstruction: a technique with a "v"-shaped patellar tunnel.

Project description:Patellofemoral dislocation is a common problem affecting the young and active population. The medial patellofemoral ligament (MPFL) is torn when the patella dislocates as it acts as a checkrein to lateral displacement. This leads to patellar instability, and MPFL reconstruction is required if the dislocation recurs after a trial of rehabilitation. We describe a "V"-shaped patellar tunnel technique to reconstruct the MPFL using an autologous gracilis graft. This modification of the patellar tunnel does not breach the lateral cortex of the patella, and it allows a broader attachment of the tendon graft to the patella, which mimics the normal anatomic attachment of the MPFL to the patella.

| S-EPMC4246370 | biostudies-literature

Single-Incision, Single Patellar Tunnel For Double-Bundle Medial Patellofemoral Ligament Reconstruction: A Technical Note.

Project description:The medial patellofemoral ligament (MPFL) is the main medial stabilizer of the patella, while reconstruction of the ligament is a common surgery performed by orthopedic surgeons. Although several surgical methods have been described regarding MPFL reconstruction, the common goals of these surgeries are to imitate the anatomic features of the native MPFL. In the single-incision and single patellar tunnel and double-bundle MPFL reconstruction technique, we will present the anatomical footprint of the MPFL located in the medial aspect of the patella, which is filled with the graft. In this technique, graft fixation is performed in the femoral tunnel using only one bioabsorbable screw without the need for fixation in the patella.

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Medial patellofemoral ligament reconstruction with semitendinosus autograft.

Project description:Patellar instability is a common complaint after traumatic dislocation of the patella. Traumatic dislocation always leads to tearing of the medial patellofemoral ligament (MPFL). Treatment consists of recovery from the traumatic injury, followed by reconditioning and physical therapy to strengthen the dynamic stabilizers of the patella. In patients with recurrent instability, detailed evaluation of the cause is required to determine the needed interventions. In patients with an incompetent MPFL and recurrent instability, reconstruction is indicated, along with other procedures to address other contributing factors. This article details our technique for MPFL reconstruction using semitendinosus autograft, which can be performed alone or in concert with other realignment procedures.

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Double-Bundle Medial Patellofemoral Ligament Reconstruction With Allograft.

Project description:Medial patellofemoral ligament (MPFL) reconstruction is the treatment of choice for recurrent patellofemoral instability. Although attention to MPFL reconstruction in the orthopaedic literature has increased dramatically in recent years, there is no clear consensus on surgical technique, graft option, or method of fixation. Nevertheless, most studies have shown improved pain scores and low rates of recurrent dislocation in patients after surgery. Despite the early success of MPFL reconstruction, complications may occur more frequently than previously appreciated and include patellar fracture, postoperative instability, and loss of flexion. This article describes our technique for double-bundle MPFL reconstruction with an allograft while highlighting certain aspects of the procedure that are critical for achieving favorable outcomes. The main advantages of the technique include strong patellar fixation with suture anchors and anatomic graft placement at the origin and insertion of the native MPFL. In our experience, this method of reconstruction has been safe, reproducible, and effective in the treatment of patients with patellar instability.

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Medial Patellofemoral Ligament Reconstruction With Concomitant Lateral Patellofemoral Reconstruction for Patellar Instability.

Project description:Patients with bidirectional patellar instability who are unresponsive to conservative management may benefit from a medial patellofemoral ligament (MPFL) reconstruction and lateral patellofemoral ligament (LPFL) reconstruction. If an isolated MPFL reconstruction does not provide adequate stabilization intraoperatively, combined MPFL and LPFL reconstruction allows independent reconstruction, which can be performed with a facile, reproducible technique. The purpose of this report was to describe our technique for performing an MPFL reconstruction with a concurrent soft-tissue LPFL reconstruction combined with a distalizing tibial tubercle osteotomy to correct patella alta.

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Wide Patellar Insertion Medial Patellofemoral Ligament Reconstruction with Internal Bracing.

Project description:Medial patellofemoral ligament (MPFL) reconstruction is a common procedure to address MPFL deficiency. Various techniques have been reported, with the best method still being pursued. Previous studies have revealed the advantage of internal bracing and possible advantage of wide patellar insertion in MPFL reconstruction. Thus, we would like to introduce a technique that combines the internal bracing and wide patellar insertion in MPFL reconstruction, in which the critical points are proper location of the patellar and femoral tunnels and proper tensioning of the augmenting sutures and the whole graft complex. Our clinical experience indicates that the proper application of this technique can lead to satisfactory clinical outcome. We consider the introduction of this technique will provide more insight to MPFL reconstruction.

| S-EPMC8626702 | biostudies-literature

Combined Medial Patellofemoral Ligament and Medial Patellotibial Ligament Reconstruction for Recurrent Lateral Patellar Dislocation in Flexion.

Project description:Recurrent lateral patellar dislocation can be a challenging entity to manage. It results from an imbalance between the restraints to lateralization of the patella and the forces applied to the patella within the biomechanical environment of the knee. The medial patellofemoral ligament has been recognized as the most important static soft-tissue restraint. However, the medial patellotibial ligament and medial patellomeniscal ligament are important for patellar stability at higher degrees of knee flexion. Lateral patellar dislocation in flexion poses a particularly challenging clinical entity with a combination of unique characteristics that need to be addressed to achieve optimal patellar tracking and stability. In this technical note, we describe a combined medial patellofemoral ligament and medial patellotibial ligament reconstruction technique to address lateral patellar dislocation in flexion.

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

Project description: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.

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Surgical Technique: Anatomic Medial Patellofemoral Ligament Retensioning Repair.

Project description:The medial patellofemoral ligament (MPFL) and the MPFL/vastus medialis obliquus complex are essential for patellar stability. Insufficiency of the MPFL can lead to altered biomechanics and patellofemoral joint contact pressure, high recurrence rate, osteochondral lesions, compromised knee function, and patellofemoral osteoarthritis. Most frequently surgical reconstruction of the MPFL is performed to address patellar instability; however, open physis and donor site morbidity can be a concern. This Technical Note presents a surgical technique to identify the insufficient MPFL and describes in detail an anatomical retensioning repair of the MPFL to restore patellar stability.

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