Deep Transverse Lateral Retinaculum Reconstruction for Medial Patellar Instability

Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Monllau, Joan Carles; Andrish, Jack T.

doi:10.1016/j.eats.2015.02.003

Cited by 7 publications

(4 citation statements)

References 14 publications

(25 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study showed no pathological findings. Extensive LRR might lead to iatrogenic medial patellar instability or a patellar multidirectional instability that would require a reconstruction of the lateral patellar retinaculum[ 24 - 26 ].…”

Section: Failed Mpfl Reconstruction Due To An Incorrect Assessment Ofmentioning

confidence: 99%

See 1 more Smart Citation

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Sanchis-Alfonso

Montesinos-Berry

Ramírez-Fuentes

et al. 2017

WJO

Self Cite

View full text Add to dashboard Cite

Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.

show abstract

Section: Failed Mpfl Reconstruction Due To An Incorrect Assessment Ofmentioning

confidence: 99%

“…Also in cases where an extensive LRR had been performed, a reconstruction of this lateral retinaculum would be necessary[ 26 ]. This surgery should only be performed after a detailed radiological assessment of medial patellar instability.…”

Section: Failed Mpfl Reconstruction Due To An Incorrect Assessment Ofmentioning

confidence: 99%

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Sanchis-Alfonso

Montesinos-Berry

Ramírez-Fuentes

et al. 2017

WJO

Self Cite

View full text Add to dashboard Cite

show abstract

“…In patients who have had prior lateral releases, multiple reconstructive techniques have been described, which could perhaps be utilized in place of a dermal allograft. For example, Sanchis-Alfonso et al 16,17 described performing a deep transverse lateral retinaculum reconstruction using an anterior strip of the iliotibial band for patients with medial The medial patellofemoral ligament graft is then shuttled with a hemostat under the retinaculum and sequentially inserted into the femoral tunnel that was created at Schottle's point using a guide pin followed by a reamer that is 1 mm in diameter larger than the graft diameter. Intraoperative image of the left knee of the patient positioned supine on the operating table with the foot of the bed lowered and the nonoperative extremity in lithotomy position.…”

Section: Discussionmentioning

confidence: 99%

Surgical Technique for Obligate Flexion Patellar Dislocation: Medial Patellofemoral Ligament Reconstruction, Distal Femoral Osteotomy, Quadricepsplasty, and Lateral Retinacular Reconstruction with Dermal Allograft

Huddleston

Bodendorfer

Yanke

2021

Arthroscopy Techniques

View full text Add to dashboard Cite

Lateral patellar dislocation is a relatively common pathology that can be surgically treated with a medial patellofemoral ligament reconstruction. In rare occurrences patients can present with patellar maltracking that results in obligate patellar instability in flexion but central tracking in extension. This presentation can be much more complicated to treat surgically and may require a combination of multiple patellofemoral procedures. In this technique we describe a four-pronged treatment approach for improving patellar tracking in a patient with obligate flexion patellar dislocation and valgus malalignment including VY quadricepsplasty, distal femoral osteotomy, medial patellofemoral ligament reconstruction, and lateral retinacular and capsular reconstruction with a dermal allograft.

show abstract

“…29 Lateral patellofemoral ligament (LPFL) reconstruction is one treatment option for patients with iatrogenic medial instability secondary to lateral retinacular release that has demonstrated improved patient outcomes in multiple case series. 3,4,21,22,34 To successfully perform an LPFL reconstruction, a comprehensive understanding of the LPFL anatomy and biomechanics is required. In addition, a better understanding of the accessory lateral stabilizers, including the lateral patellomeniscal ligament (LPML) and lateral patellotibial ligament (LPTL), may lead to development and evolution in the surgical reconstruction of these structures, analogous to how the medial patellotibial ligament (MPTL) can be reconstructed in isolation or in addition to a medial patellofemoral ligament (MPFL) reconstructions which have been shown to improve outcomes in specific patient cohorts.…”

mentioning

confidence: 99%

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry

et al. 2022

View full text Add to dashboard Cite

Background: The lateral patellofemoral complex (LPFC) is an important stabilizer of the patella composed of the lateral retinacular structures including the lateral patellofemoral ligament (LPFL), the lateral patellomeniscal ligament (LPML), and the lateral patellotibial ligament (LPTL). While the isolated anatomy of the LPFL has been previously described, no previous study has investigated the entirety of the LPFC structure, length changes, and radiographic landmarks. An understanding of LPFC anatomy is important in the setting of LPFL injury or previous lateral release resulting in iatrogenic medial instability requiring LPFC reconstruction. Purpose: To both qualitatively and quantitatively describe the anatomy and length changes of the LPFC on gross anatomic dissections and standard radiographic views. Study Design: Descriptive laboratory study. Methods: Ten nonpaired cadaveric specimens were utilized in this study. Specimens were dissected to identify distinct attachments of the LPFL, LPML, and LPTL. Ligament lengths, footprints, and centers of each attachment were described with respect to osseous landmarks using a 3-dimensional coordinate measuring device. Ligament length changes were also assessed from 0° to 90° of flexion. Radiopaque markers were subsequently utilized to describe attachments on standard anteroposterior and lateral radiographic views. Results: The individual elements of the LPFC were identified in all specimens. The LPFL patellar attachment had an average total length of 22.5 mm (range, 18.3-27.5 mm), involving a mean of 59% (range, 50%-75%) of the sagittal patella. Based on the average patellar size, a mean of 63% of the LPFL attached to the patella, and the remainder (11.1 ± 1.4 mm) inserted into the patellar tendon. The femoral attachment of the LPFL had a mean maximum length of 24.4 ± 4.3 mm. The center of the LPFL femoral attachment was a mean distance of 13.5 ± 3.2 mm anterior and distal to the lateral epicondyle. The LPFL demonstrated significant shortening, especially in the first 45° of flexion (7.5 ± 5.1 mm). In contrast, the LPTL (5.5 ± 3.0 mm) and LPML (10.0 ± 3.3 mm) demonstrated significant shortening from 45° to 90°. On lateral radiographs, the center of the femoral attachment of the LPFL was a mean total distance of 19.2 ± 7.2 mm from the lateral epicondyle. Conclusion: The most important findings of this study were the correlative anatomy of 3 distinct lateral patellar ligaments (LPFL, LPML, and LPTL) and their anisometry through flexion. All 3 components demonstrated significant shortening during flexion. The quantitative and radiographic measurements detailed the LPFL osseous attachment on the patella; soft tissue attachment on the patellar tendon; and finally, the osseous insertion on the femur distal and anterior to the lateral epicondyle. Similarly, the authors documented the meniscal insertion of the LPML and defined a patellar insertion of the LPTL and LPML as a single attachment. These data allow for reproducible landmarks to aid in the understanding and reconstruction of the lateral patellar restraints. Clinical Relevance: The data produced from this investigation provide a comprehensive description of these 3 lateral patellar stabilizers (LPFL, LPML, LPTL). These data can be used intraoperatively to facilitate anatomic reconstructions of the lateral patellar stabilizers.

show abstract

Deep Transverse Lateral Retinaculum Reconstruction for Medial Patellar Instability

Cited by 7 publications

References 14 publications

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Surgical Technique for Obligate Flexion Patellar Dislocation: Medial Patellofemoral Ligament Reconstruction, Distal Femoral Osteotomy, Quadricepsplasty, and Lateral Retinacular Reconstruction with Dermal Allograft

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry

Contact Info

Product

Resources

About