Medial Patellofemoral Ligament Reconstruction Using Gracilis Tendon Graft and "All Suture" Knotless Anchors for Patellar Fixation

Abstract

Patellar dislocation is a frequent sports-related knee injury. The primary restraint to lateral translation of patella is medial patellofemoral ligament. Several treatments for patella dislocation have been described in the literature. The purpose of this Technical Note is to describe the surgical technique for medial patellofemoral ligament reconstruction using gracilis tendon and 2 knotless soft anchors, avoiding patella tunneling.

Fig 1

Medial view, supine position of a left knee, the medial retinaculum is identified and dissected, with exposure of the periosteum of the medial patella.

Fig 2

Medial view, supine position of a left knee. The distance (dotted line) between the anchors is approximately 0.8 to 1 cm.

Fig 3

Medial view, knee flexed to 90°. The second skin incision (line A) at the medial epicondyle is drawn parallel to the first patellar incision line (B).

Fig 4

Medial view, supine position of a left knee, knee in full extension, soft-tissue tunnel placed between 2 to 3 layers of the medial retinaculum, avoid to violate joint capsule.

Fig 5

Medial view, supine position of a left knee. (A) Fixation of the graft using knotless all-suture anchors (black arrow), to restore the anatomical attachment of the native medial patellofemoral ligament on the patella.

Fig 6

Medial view, knee flexed approximately to 90°. (A) The Schöttle point (circle) is identified on a lateral radiograph. Radiographically, originates slightly anterior to the posterior femoral cortex reference line and immediately posterior to the most posterior aspect of the Blumensaat line. (B) The closed eyelet K-wire is shuttled medial to lateral transversely to the distal femur.