Anatomical Double-Bundle Medial Patellofemoral Ligament Reconstruction With Autologous Semitendinosus, a Single Patellar Tunnel Technique

Abstract

Patellofemoral instability is one of the knee problems that can be found in up to 3% of knee injuries, especially in younger aged females. Recent biomechanical studies showed that the main soft tissue stabilizer for patellofemoral stability is the medial patellofemoral ligament (MPFL). More than 200 articles on MPFL reconstruction have been published. Some surgical techniques create multiple holes in the patellar area that may increase the risk of patellar fractures. This technique that we present here attempts to reduce the chance of patella-related complications, while maintaining stability of the reconstructed construct, reducing the use of a lengthy tendon graft within the patella and covering the footprint at the border of the patella closed to the native anatomy of the MPFL. Failed conservative treatment Recurrent patellar instability Patellar subluxation/dislocations -With ongoing instability, pain, or symptomS -Associated osteochondral fracture Loose osteochondral fracture Active sports participation

Functional outcomes of medial patellofemoral ligament reconstruction using the superficial quadriceps versus a hamstring autograft in patellar instability patients: a retrospective comparative study.

“…A 2.0 mm Kirshner wire was inserted at the midpoint of the medial border of the patella through the center. The single patellar tunnel [13] was created with a 4.5 mm EndoButton reamer (Smith & Nephew, Andover, MA US.). The semitendinosus graft was passed through the patella tunnel with a suture loop.…”

Surgical techniques for medial Patellofemoral ligament reconstruction: a systematic review and meta‐analysis of level I and II studies

“…Differences in graft types, such as autografts, allografts and synthetic grafts, have been studied over the years, each offering unique benefits and drawbacks [26]. Autografts, including the semitendinosus or gracilis tendon, are often preferred due to their biocompatibility, faster incorporation, and easy accessibility [14, 21]. With regard to tunnel techniques, there is the single‐tunnel (ST) technique, which involves drilling one tunnel in the femur and one in the patella [21, 36].…”

“…Autografts, including the semitendinosus or gracilis tendon, are often preferred due to their biocompatibility, faster incorporation, and easy accessibility [14, 21]. With regard to tunnel techniques, there is the single‐tunnel (ST) technique, which involves drilling one tunnel in the femur and one in the patella [21, 36]. In contrast, the double‐tunnel (DT) technique involves drilling two tunnels in the patella and one in the femur [28].…”

“…Despite various individual studies on graft options, tunnel techniques, and fixation strategies, there is no comprehensive source outlining the optimal strategies for each aspect of MPFLR. Thus, usage of various grafts and techniques can be dependent on surgeon preference [14, 21]. This systematic review of level I and II studies aims to critically evaluate the current literature on surgical techniques for MPFLR and aims to summarize the highest quality evidence available for orthopedic surgeons to use during their preoperative plans for this patient population.…”

A Patella-Sided Tensioning Technique for Medial Patellofemoral Ligament Reconstruction

“… 6 , 12 , 14 , 15 They differ both in the type of graft used (patellar tendon vs. quadriceps tendon and autograft vs. cadaver allograft), as well as in the patellar and femoral fixation methods, such as anchors and interference screws, as well as transosseous tunnels. 16 , 17 , 18 , 19 However, to date, there is no consensus on a superior method of MPFL reconstruction.…”