Dataset Information

Medial Patellofemoral Ligament Reconstruction Using All-Soft Suture Anchors for Patellar Fixation.

ABSTRACT: 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.

SUBMITTER: Makovicka JL

PROVIDER: S-EPMC5989692 | biostudies-other | 2018 Mar

REPOSITORIES: biostudies-other

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Publications

Medial Patellofemoral Ligament Reconstruction Using All-Soft Suture Anchors for Patellar Fixation.

Makovicka Justin L JL Hartigan David E DE Patel Karan A KA Tummala Sailesh V SV Chhabra Anikar A

Arthroscopy techniques 20180212 3

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 u ...[more]

PMID: 29881694

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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. Technique Video Video 1 Wide patellar insertion medial patellofemoral ligament reconstruction with internal bracing. This procedure is performed in the left leg. The anterior half of the peroneus longus tendon is harvested. Both ends of the tendon are braided with nonabsorbable sutures. All parts of the knee are examined and debrided. The MPJ point on the medial edge of the patella is defined. A medial patellar incision is made over the MPJ (junction of the medial and proximal one-third). Two tunnels are created from the medial edge of the patella to the midline of the anterior surface of the patella. A longitudinal incision is made over the medial femoral epicondyle and the adductor tubercle. The femoral tunnel is located and created. Two guide sutures are passed though the patellar tunnels. The graft tendon along with 2 augmenting sutures are passed through the proximal tunnel and pulled back through the distal tunnel. Lateral retinaculum release is performed as indicated. The tendon and the augmenting sutures are pulled subcutaneously out of the medial incision. A cortical suspensory fixation device with an adjustable loop is passed through the femoral tunnel from the medial to the lateral side. Each tendon end, as well as the augmenting sutures are tied to the adjustable loop. A lateral incision is made. The sutures from the adjustable loop are pulled through the soft-tissue fissure resulting from the lateral retinaculum release out of the lateral incision. The cortical fixation device is pulled through the femoral tunnel till the tendon ends are pulled into the femoral tunnel. The arthroscope is placed to the lateral gutter of the knee though the anterolateral portal. The adjustable loop is reduced until the cortical fixation button is pulled back against the lateral orifice of the femoral tunnel. At 30? flexion of the knee, lateral displacement of the patella is checked to make sure that the medial stability of the patella is restored. (MPJ, medial–proximal junction.)

Dataset Information

Medial Patellofemoral Ligament Reconstruction Using All-Soft Suture Anchors for Patellar Fixation.

Publications

Medial Patellofemoral Ligament Reconstruction Using All-Soft Suture Anchors for Patellar Fixation.

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