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. 2014 May 12;3(3):e325-9.
doi: 10.1016/j.eats.2014.01.012. eCollection 2014 Jun.

Minimally invasive reconstruction of the medial patellofemoral ligament using quadriceps tendon

Christian Fink  1 , Matjaz Veselko  2 , Mirco Herbort  3 , Christian Hoser  1
Affiliations

Minimally invasive reconstruction of the medial patellofemoral ligament using quadriceps tendon

Christian Fink et al. Arthrosc Tech. .

Abstract

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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Figures

Fig 1
Fig 1
Step 1 of graft harvest: A double knife of 10 or 12 mm is pushed proximally 8 to 10 cm above the superior patellar border.
Fig 2
Fig 2
Step 2 of graft harvest: A tendon separator (3 mm) is pushed proximally 8 to 10 cm above the superior patellar border.
Fig 3
Fig 3
Step 3 of graft harvest: The quadriceps tendon strip is cut at the desired length (8 to 10 cm) with a tendon cutter.
Fig 4
Fig 4
The tendon strip is left attached on the patella on 1 side, and the free end is augmented with resorbable No. 2-0 sutures by use of a baseball-stitch technique.
Fig 5
Fig 5
The quadriceps tendon strip is detached from the bony surface of the patella.
Fig 6
Fig 6
From the medial patellar border, the prepatellar tissue is elevated, creating a tunnel. The graft is passed through the tunnel and secured to the tissue on the medial patellar border with No. 2-0 sutures.
See this image and copyright information in PMC

References

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