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Simultaneous Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament Reconstructions Using an Artificial Ligament for Lateral Patella Instability.

ABSTRACT: 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.

SUBMITTER: Shimodaira H

PROVIDER: S-EPMC9244637 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Medial quadriceps tendon-femoral ligament: surgical anatomy and reconstruction technique to prevent patella instability.

Project description:Detailed anatomic dissections of the deep medial knee retinaculum have shown a consistent prominent anatomic structure extending from the distal deep quadriceps tendon to the adductor tubercle region, forming a distinct medial quadriceps tendon-femoral ligament (MQTFL). Reconstruction of this anatomic structure has yielded consistent medial stabilization of the patellofemoral joint without drilling into the patella over more than 3 years in patients with recurrent patella instability and dislocation. Results are similar to those of MPFL reconstruction but with reduced risk of patella fracture, a known and serious complication of MPFL reconstruction. The reconstruction graft is secured at the anatomic femoral origin of the MQTFL and brought under the vastus medialis such that it may be woven and attached to the deep distal medial quadriceps tendon to provide a secure, reliable reproduction of the MQTFL and excellent stabilization of the patellofemoral joint without risk of patella fracture.

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

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

Project description:Most patellar dislocations are associated with disruption of the proximal medial patellar restraints (PMPRs). The PMPRs comprise the medial patellofemoral ligament (MPFL) and medial quadriceps tendon-femoral ligament (MQTFL). Although isolated MPFL reconstruction is the most frequently performed procedure for the surgical management of recurrent dislocation, recent studies have shown that the MQTFL has a synergistic role with the MPFL in resisting lateral patellar displacement close to full extension. It has therefore been suggested that surgical techniques that gain the benefits of both proximal and distal PMPR biomechanical behavior may be best. This article describes an established technique for combined MPFL and MQTFL reconstruction using semitendinosus autograft.

| S-EPMC7823114 | biostudies-literature

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

Project description:Patellar dislocation is a major orthopaedic concern in pediatric and adult populations, with both conservative and surgical options available. Several surgical techniques of the combined or isolated reconstruction of the medial patellofemoral ligament are described in the literature using different grafts, locations, and types of fixations, providing different advantages and disadvantages. New recent developments in cadaveric dissection studies have unveiled the importance of structures that were neglected until recently, such as the medial quadriceps tendon-femoral ligament, which provides a connection between the medial femur and the quadriceps tendon component of the knee extensor mechanism. Hence, we present a surgical technique with combined reconstruction of the medial patellofemoral ligament and medial quadriceps tendon-femoral ligament without the use of hardware and with no need for patellar or femoral drilling (no physis compromise or risk of patellar fracture), which can be used concomitantly with other bony procedures.

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Medial Quadriceps Tendon Femoral Ligament Reconstruction for Anatomic Reconstruction of the Medial Patellofemoral Complex.

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Combined Biplanar Medial Closing-Wedge Distal Femoral Osteotomy and Quadriceps Tendon Medial Patellofemoral Ligament Reconstruction.

Project description:Lateral patellofemoral instability is multifactorial in etiology, with bony and soft-tissue factors contributing. Coronal plane alignment, in particular genu valgum, is important to consider when evaluating lateral patellofemoral instability. When genu valgum is present and thought to be a significant contributing factor, we typically address this with an extra-articular, biplanar, medial closing-wedge distal femoral osteotomy (DFO). This can be combined with a medial patellofemoral ligament reconstruction using a partial-thickness quadriceps tendon graft via the same incision. A medial closing-wedge DFO with locking plate fixation affords a highly stable construct suitable for early weight-bearing. The locking plate is less prominent as compared with a lateral opening-wedge DFO, and it does not irritate the iliotibial band or cause tightening of the illiopatellar expansion. The biplanar nature of the osteotomy prevents extension of the osteotomy into the proximal trochlear, helps to control rotation in both axial and sagittal plane after wedge removal, and increases the bony surface area for healing. The quadriceps tendon medial patellofemoral ligament reconstruction allows a graft that can be tailored in terms of length and diameter, does not require an anchor on the patellar, and can be performed through the same incision as for the DFO.

| S-EPMC8322471 | biostudies-literature

Minimally invasive reconstruction of the medial patellofemoral ligament using quadriceps tendon.

Project description:Reconstruction of the medial patellofemoral ligament (MPFL) for the treatment of patellar instability has received increased attention over the past few years. Most operative techniques use hamstring grafts fixed with bone tunnels and/or anchors on the patella. Despite good clinical results using these techniques, complications such as implant breakage, patellar fractures through bone tunnels, and loss of knee motion have occurred. We present a minimally invasive technique for MPFL reconstruction using a strip of quadriceps tendon. With the use of specially designed instruments, the graft is harvested through a 3-cm transverse incision at the proximal pole of the patella. The tendon strip is then dissected distally on the patella, left attached, and diverged 90° medially underneath the medial prepatellar tissue. The graft is fixed on the femur in 20° of knee flexion in a bone tunnel with a bioabsorbable interference screw (adults) or a bone anchor (children). We think that this technique presents a valuable alternative to common hamstring techniques for primary MPFL reconstruction in children and adults, as well as for MPFL revision surgery.

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Medial Quadriceps Tendon Femoral Ligament Reconstruction Technique and Surgical Anatomy.

Project description:Medial patellofemoral ligament reconstruction risks patellar fracture with the osseous violation necessary for patellar attachment. Anatomic studies identify an entire medial patellofemoral complex of structures responsible for medial restraint to patellar lateral instability. One specific component of this complex is the medial quadriceps tendon femoral ligament (MQTFL). This note presents the technique, pearls and pitfalls, and critical surgical anatomy necessary for successful MQTFL reconstruction-a treatment strategy for patellar instability with no increased risk for patellar fracture. An autograft hamstring tendon or allograft tendon is fixed to the anatomically identified femoral origin and passed deep to the vastus medialis obliquus to then weave around the distal medial quadriceps tendon. This simulates the native anatomic interdigitation of the MQTFL with the quadriceps tendon and provides a stable restraint to prevent lateral patellar subluxation or dislocation.

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Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction?

Project description:BackgroundThe aim of this study was to describe outcomes of patients who had undergone medial patellofemoral ligament reconstruction (MPFLr) to treat patellofemoral instability (PFI) following total knee arthroplasty (TKA).Material and methodsThis is a retrospective case series of consecutive patients treated for PFI after TKA. Patients were included if they had radiographic documentation of patella dislocation or subluxation and component position was adequate. MPFLr was performed using a quadriceps tendon autograft. The graft was fixed with either an interference or additional suspensory fixation. A tibial tubercle osteotomy was performed in select indications. Patients were assessed with Kujala and International Knee Score (IKS) at a minimum 12-month follow-up and radiographically with plain radiographs.ResultsA total of 22 patients (23 procedures) were included. The mean follow-up period was 38 months (range 12-72). Average preoperative femoral component rotation on computed tomography was 0.10° external rotation (range 3° internal rotation to 3° external rotation). All patients had improved clinical and radiographic outcomes postoperatively. At the last follow-up, the mean IKS knee score was 77.6 ± 13.1, mean IKS function score was 75.2 ± 23.3, and mean Kujala score was 60.2/100 ± 10.9. There was 1 mechanical failure, which occurred following MPFLr with interference fixation. There were 6 complications (28.1%) postoperatively. Patients receiving double fixation of the MPFLr graft had higher clinical and radiographic scores; however, this difference was not statistically significant. MPFLr had a patella-lowering effect, 0.97 preoperatively to 0.74 postoperatively (P = .069).ConclusionMPFLr in appropriately selected patients is a satisfactory option to treat PFI following TKA.

| S-EPMC9168055 | biostudies-literature

Medial Patellofemoral Ligament Reconstruction Using a Quadriceps Tendon Autograft in a Patient with Open Physes.

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| S-EPMC8185619 | biostudies-literature

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