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. 2024 May 14;13(8):103011.
doi: 10.1016/j.eats.2024.103011. eCollection 2024 Aug.

Combined Medial Quadriceps Tendon-Femoral Ligament and Medial Patellofemoral Ligament Reconstruction for Revision Patellofemoral Soft-Tissue Stabilization

Morgan E Rizy  1 , Tyler J Uppstrom  1 , Andreas H Gomoll  1 , Sabrina M Strickland  1
Affiliations

Combined Medial Quadriceps Tendon-Femoral Ligament and Medial Patellofemoral Ligament Reconstruction for Revision Patellofemoral Soft-Tissue Stabilization

Morgan E Rizy et al. Arthrosc Tech. .

Abstract

Patients with recurrent patellofemoral instability in whom prior medial patellofemoral ligament (MPFL) reconstruction fails present unique challenges for revision soft-tissue stabilization owing to scar tissue formation, limited patellar bone stock for anchor placement, and increased risk of patellar fracture. We describe a technique for revision patellofemoral soft-tissue stabilization that combines MPFL and medial quadriceps tendon-femoral ligament reconstruction techniques through combined fixation to the patella with 1 suture anchor and soft-tissue fixation to the quadriceps tendon. The proposed technique maximizes restoration of resistance to lateral translation by attempting to re-create the native MPFL attachment and minimizes patellar fracture risk in the setting of poor bone stock through the use of a single 1.8-mm all-suture suture anchor rather than bone tunnels or multiple anchor placement for bony fixation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: A.H.G. reports a consulting or advisory relationship with Vericel, Smith & Nephew, Organogenesis, and Bioventus; receives speaking and lecture fees from Vericel, Linvatec, and Pacira Pharmaceuticals; and owns equity or stocks in Smith & Nephew. S.M.S. reports a consulting or advisory relationship with Smith & Nephew, Vericel, and Miach Orthopaedics; owns equity or stocks in Smith & Nephew; receives speaking and lecture fees from Smith & Nephew, Vericel, and Miach Orthopaedics; and receives travel reimbursement from Smith & Nephew. All other authors (M.E.R., T.J.U.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig 1
Left cadaveric knee in supine position. By use of a 4-cm medial parapatellar approach, one 1.8-mm Q-FIX anchor is placed in the medial patella at the junction of the proximal one-third and distal two-thirds of the patella.
Fig 2
Fig 2
Left cadaveric knee in supine position. (A) A medial parapatellar approach is taken to make a longitudinal incision at the junction of the medial and central one-third of the quadriceps tendon, approximately 1 cm proximal to the superior border of the patella. (B, C) After the midpoint of the gracilis allograft is secured to the Q-FIX anchor with suture, the proximal limb of the graft is passed beneath the quadriceps tendon via the prior incision, exiting from deep to superficial.
Fig 3
Fig 3
Left cadaveric knee in supine position. For femoral graft fixation of the semitendinosus allograft, a femoral tunnel is placed at the sulcus between the adductor tubercle and the medial epicondyle, measuring 35 mm in length, with a 7-mm-diameter reamer.
See this image and copyright information in PMC

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