Medial Patellofemoral Ligament Reconstruction: A Novel Technique Using the Patellar Ligament

Camanho, Gilberto Luís; Bitar, Alexandre Carneiro; Hernandez, Arnaldo José; Olivi, Rogério

doi:10.1016/j.arthro.2006.07.008

Cited by 60 publications

(81 citation statements)

References 25 publications

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“…The use of the quadricipital and patellar grafts for the reconstruction of the MPFL is already well-known and widespread, and the use of the patellar tendon for isolated reconstruction of the MPTL has also been described. 8,9,16,[18][19][20] The risks involved are similar to those described for any MPFL reconstruction: overtightening of the graft leading to pain, restricted range of motion, medial subluxation, and patella baja. Surgeons should be careful when suturing the grafts to avoid these complications.…”

Section: Discussionmentioning

confidence: 77%

“…Several types of grafts have been described for the reconstruction of the MPFL, and they have shown good results. [8][9][10] In a systematic review of the complications associated with exclusive reconstruction of the MPFL, the observed complication rate was 26.1% of cases. Clinical failure presenting with persistence of objective or subjective instability totaled 12%.…”

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confidence: 99%

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Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Hinckel

Gobbi

Demange

et al. 2016

Arthroscopy Techniques

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Although the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts.L ateral patellar dislocation is responsible for 2% to 3% of all knee injuries and is the second leading cause of hemarthrosis. 1,2 The medial ligaments responsible for maintaining the stability of the patellofemoral joint are the medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), and medial patellomeniscal ligament (MPML).There are several studies on the MPFL and its anatomic and biomechanical characteristics 2-6 ; however, little is known about the MPTL and MPML. 2,3,5,6 The first biomechanical studies showed that the MPFL contributes 50% to 60% to medial restriction during initial flexion (between 0 and 30 of flexion). [4][5][6] The contribution of the secondary restrictors varies among those studies, ranging from 0% to 24% for the MPTL and from 8% to 38% for the MPML. 3,5,6 However, in a more recent study, Philippot et al. 2 evaluated the medial ligaments in higher degrees of flexion (from 0 to 90 of flexion), showing that the contributions of the MPTL and MPML to lateral translation restriction increase from 26% in extension to 46% at 90 of flexion. In addition, the influences of the MPTL and MPML at 90 of flexion were 72% in patellar tilt and 92% in patellar rotation. 2 In the study by Philippot et al., the combined importance of the MPTL and MPML was evaluated rather than the isolated actions of each of these ligaments. In a clinical study, Garth et al. 7 observed the presence of clinical and arthroscopic subluxation in patients with isolated MPML lesions with the knee in extension. Thus the MPTL and MPML are important in maintaining normal kinematics of the patellofemoral joint in all ranges of motion, especially at extension and higher degrees of flexion.Usually, surgical treatment involves a combination of reconstruction of the injured MPFL and adjuvant procedures for better alignment and congruence of the patellofemoral joint. Several types of grafts have been described for the reconstruction of the MPFL, and they have shown good results. [8][9][10] In a systematic review of the complications associated with exclusive reconstruction of the MPFL, the observed complication rate was 26.1% of cases. Clinical failure presenting with persistence of

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Section: Discussionmentioning

confidence: 77%

mentioning

confidence: 99%

Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Hinckel

Gobbi

Demange

et al. 2016

Arthroscopy Techniques

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“…The free end of the graft was then attached to the medial epicondyle of the femur to complete MPFL reconstruction. 13 The graft was then immediately bisected at the middle third to simulate reconstruction failure, as in groups I and II. Again, the lateral traction apparatus was used as described above (Fig.…”

Section: Operative Techniquementioning

confidence: 99%

“…11,12 The patellar and quadriceps tendons provide a strong posterior force vector during flexion of the knee, thus increasing stability during this motion. 2 Therefore, surgical procedures that use these structures for MPFL reconstruction 13 actually carry the risk of aggravating patellar instability in the event of reconstructive failure, leading to a further decline in the patient's condition, whereas techniques employing structures that do not play a primary role in patellofemoral stability 4 should be comparatively safer. Therefore, this experiment compared preoperative and post-simulated failure patellofemoral instability in cadavers subjected to these procedures.…”

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confidence: 99%

Mechanical testing of patellofemoral instability after induced failure of the patellofemoral ligament reconstruction using four differents cadavers grafts

Freitas

Gomes

Abdala

2015

Journal of Orthopaedics

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Instability MPFL reconstruction Failure a b s t r a c tPurpose: To ascertain whether differences exist in joint instability after experimentally induced failure of medial patellofemoral ligament (MPFL) reconstruction in the cadaver knee with the four graft types most widely used for this procedure, and whether any of these grafts are associated with decreased risk in the event of failure.Methods: Between March 2011 and March 2012, eight cadavers obtained from the local medical examiner's office were randomly allocated into four groups (four knees each). In each group, a different graft technique was used for MPFL reconstruction. The forces required to induce lateral dislocation of the patella before reconstruction and after experimental failure of surgical reconstruction were recorded. The tested graft techniques were then compared to assess which was associated with the least instability after failed reconstruction.Results: When we compared the groups I (semitendinosus) and II (patellar tendon), the mean differences of the force required to produce a dislocation of the patella before and after the failure were 0.5 N and 12.5 N, respectively (p ¼ 0.028). In comparison between groups I and III (medial third of the quadriceps tendon) the mean differences of the force required to produce dislocation before and after the failure caused were 0.5 N and 22 N, respectively (p < 0.001). In comparison between groups I and IV (Medial third of the quadriceps tendon) we found the mean differences of the force required to produce dislocation before and after the failure caused were 0.5 N and 5 N, respectively (p > 0.999).Conclusions: There were differences in residual instability after simulated MPFL reconstruction failure depending on graft type. Use of the free semitendinosus graft technique was associated with the least risk of residual instability in case of reconstruction failure.

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“…The study of the disorders between the patella and femur is of great relevance not only for their high prevalence but also for the expressive number of cases of difficult solution, especially in athletes, this context becomes more complex (1,2) The current literature has emphasized the importance of the injury of the medial patellofemoral ligament (MPFL) in acute patellar luxation, since it is the main static stabilizer of the medial side of the patella and is the first structure injured in this condition (1)(2)3,4) (figure 1). Many authors use different imaging methods to refer to the MFPL injury as an essential factor in the patellar instability after an acute patellar luxation episode (5)(6)(7) .…”

Section: Introductionmentioning

confidence: 99%

Importância do ligamento femoropatelar medial no deslocamento e na inclinação lateral da patela: estudo radiográfico em cadáveres

Fávaro

Severino²,

Fávaro

et al. 2011

Rev Bras Med Esporte

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Objective: Acute patellar luxation is a complex disease that mainly affects young patients. Its physiopathology is little known and the understanding of it and its therapeutic conduct are controversial. The medial patellofemoral ligament (MPFL) is the main static stabilizer for preventing lateral displacement of the patella. In order to assess the stability of the patellofemoral joint, the authors radiographically assessed the presence, or absence of lateral displacement and inclination of the patella before and after the MPFL section in the knees of cadavers. Methods: Thirty knees of cadavers were radiographed on the axial incidence of the patella by means of the technique described by Merchant before and after MPFL section. The Merchant congruence angle and Laurin lateral patellofemoral angle were measured. Results: The medial patellofemoral ligament presented mean length of 4.8cm, and width of 1.6 cm. In six anatomical pieces there was no change in the Laurin lateral patellofemoral angle (20%), in three anatomical pieces the change was one degree (10%), in 20 (67%) two degrees and in one anatomical piece it was four degrees (3%). Changes occurred between zero and two degrees in 97% of the knees of cadavers. In six anatomical pieces there was no change in the Merchant congruence angle (17%); in six anatomical pieces the change was one degree (20%), in 17 (57%) two degrees, in one anatomical piece it was three degrees (3%) and in one it was six degrees (3%). These changes occurred between zero and two degrees in 93% of the knees of cadavers. Conclusion: Analysis of the results obtained in this study allowed us to conclude that the medial patellofemoral ligament is important in the lateral inclination and displacement of the patella with knee flexed at 45º.

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Medial Patellofemoral Ligament Reconstruction: A Novel Technique Using the Patellar Ligament

Cited by 60 publications

References 25 publications

Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Mechanical testing of patellofemoral instability after induced failure of the patellofemoral ligament reconstruction using four differents cadavers grafts

Importância do ligamento femoropatelar medial no deslocamento e na inclinação lateral da patela: estudo radiográfico em cadáveres

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