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. 2014 Apr 28;3(2):e303-8.
doi: 10.1016/j.eats.2014.01.005. eCollection 2014 Apr.

Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft

Manfred Nelitz  1 , Sean Robert M Williams  1
Affiliations

Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft

Manfred Nelitz et al. Arthrosc Tech. .

Abstract

Reconstruction of the medial patellofemoral ligament (MPFL) has recently become a popular procedure for children and adolescents with patellofemoral instability. Nevertheless, high complication rates of up to 26% have been reported. The traditionally used technique requires patellar bone tunnels that may place the proportionately smaller patella at higher risk of fracture. Because of the adjacent physis of the femoral insertion, anatomic reconstruction of the MPFL has the risk of injury to the growth plate. This technical report therefore presents a technique for anatomic reconstruction of the MPFL in a skeletally immature population using a pedicled superficial quadriceps tendon graft, hardware-free patellar graft attachment, and anatomic femoral fixation distal to the femoral physis. The advantages of this technique include avoidance of bony patellar complications, an anatomically truer reconstruction, a single incision, and sparing of the hamstring tendons for reconstruction of any future ligamentous injuries.

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Figures

Fig 1
Fig 1
The skin incision is made at the superomedial border of the patella. In our experience a modest incision length of 4 to 5 cm is adequate.
Fig 2
Fig 2
(A) The incision is made 2 to 4 mm lateral to the border of the vastus medialis, thus preserving a thin strip of the medial tendon. The superficial slip of the quadriceps tendon is elevated from the deeper tendon. (B) Staying in the same plane, the graft is then carefully dissected superiorly, keeping the middle and deep laminae intact.
Fig 3
Fig 3
The pedicled graft is reflected 180° and rotated 90° toward medial. Care is taken not to accidentally divide the graft at its inferior attachment to the patella during dissection. The free end of the graft is prepared with a Vicryl suture.
Fig 4
Fig 4
The graft matches the native MPFL, which is a thin, broad, sheet-like ligament. The length of the graft measures approximately 9 cm. The width of the graft is approximately 10 mm, which resembles the width of the original MPFL.
Fig 5
Fig 5
A bioresorbable interference screw is used to secure the quadriceps graft within the medial condyle tunnel with the knee flexed to 30°. Reprinted with permission.
Fig 6
Fig 6
Closure of wound, which typically has a length of 4 to 5 cm.
See this image and copyright information in PMC

Comment in

References

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