Medial Quadriceps Tendon-Femoral Ligament (MQTFL) Reconstruction for Patellofemoral Instability

Abstract

were included. 28/38 (74%) successfully completed non-op treatment whereas 10/38 (26%) failed after a median of 44 days (range, 6-511) from the initiation of physical therapy. Of the 10 patients who failed, 9 (90%) sought treatment >30 days after the injury. Two of these patients had a subsequent surgery before final follow-up and were therefore not included in outcomes analysis. Follow-up was available for the remaining 7/8 patients (87.5%) who failed non-op treatment and for 22/28 patients (78%) who were successfully treated nonop. Mean follow up was 3.3 years (range, 2.0-5.9). Although there were no significant differences in outcomes scores between groups (Table1; p >0.05), those who sought treatment >30 days after injury demonstrated decreased postoperative SANE scores (p ¼ 0.002) and had 13.8x greater relative risk for failure of non-op treatment. Conclusion: Surgical decision making after acute grade 3 injuries is evolving. Based on our data, we conclude that (1) a trial of non-op treatment as warranted as successful outcomes can be expected even in those that eventually opt for surgery, and (2) oatients who present >30 days after their injury are much less likely to complete nonoperative treatment successfully.

Medial Quadriceps Tendon-Femoral Ligament Reconstruction: A Technique Description and Short-Term Outcomes

“…14,[23][24][25][26] Anatomic reconstruction of the MQTFL with either the Fulkerson method or our sling variation also avoids transosseous fixation and has obtained excellent subjective and objective results at short-term follow-up. The only other report of this technique is by Fulkerson and Edgar, 1 with their follow-up as reported by Barden et al 17 In their original description of the technique, Fulkerson and Edgar reported 1-year follow-up of 17 patients who had MQTFL reconstruction; none had a recurrence of patellar instability. The later report by Barden and colleagues described a 3-year follow-up of 28 patients (29 knees) with MQTFL reconstruction, none of whom experienced a complete dislocation, 26 (93%) of the 28 patients were satisfied with their surgical outcomes, and 25 (89%) were able to return to the same or higher level of activity.…”

“…Their cohort experienced a high-rate of return to sport (89%) and no recurrent dislocations, but apparently, 3 patients did have some remaining instability. 1,17 In their technique, the graft is sutured into the distal quadriceps tendon. We describe a modification of this technique, in which a sling is created in the distal quadriceps tendon, the graft is doubled back, and both ends are fixed at the femoral isometric point.…”

“…Fulkerson and Edgar1 described a technique that avoids transosseous fixation by anatomically reconstructing the MQTFL, with promising early results. Their cohort experienced a high-rate of return to sport (89%) and no recurrent dislocations, but apparently, 3 patients did have some remaining instability 1,17. In their technique, the graft is sutured into the distal quadriceps tendon.…”