Patella Footprint Technique—A Surgical Method for Medial Patellofemoral Ligament Reconstruction

Kurowicki, Jennifer; Mease, Samuel J.; Palacios, Steven; Festa, Anthony; McInerney, Vincent K.; Scillia, Anthony J.

doi:10.1016/j.eats.2018.02.004

“…We have previously reported our surgical technique of MPFL reconstruction that uses two suture anchors along the patella for graft fixation to provide a biomechanically favorable construct [130]. In our clinical experience, anatomic MPFL reconstruction (utilizing the autogenous gracilis tendon and patella footprint technique) has produced satisfactory clinical and functional outcomes in majority of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…The asterisks (*) indicate the placement of 2 GRYPHON suture anchors (DePuy Mitek) approximately 5 mm to 10 mm from each other. Reproduced with permission from: Kurowicki et al[130].…”

mentioning

confidence: 99%

“…Gracilis tendon provides a stronger construct compared with the native MPFL while limiting hamstring morbidity 4. ensioning in 45° of knee flexion allows for some bony restraint by trochlea yet prevents overtensioning of the graft5. L-configuration diminishes patellar rotationDisadvantages Interference screw fixation on the patellar side provides a biomechanically stronger fixation as compared with the suture anchor fixation[154] * Adapted from Kurowicki et al[130].…”

mentioning

confidence: 99%

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Patellofemoral Instability

Patel¹,

Castrodad²,

Kurowicki³

et al. 2022

Arthroscopy

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Recurrent patellofemoral instability is a common cause of knee pain and functional disability in adolescent and young adult patients, resulting in loss of time from work and sports. There are numerous factors that contribute to recurrent patellofemoral instability; these factors include tear of the medial patellofemoral ligament (MPFL), weakening or hypoplasia of the vastus medialis obliquus (VMO), trochlear dysplasia, increased tibial tuberosity-trochlear groove (TT-TG) distance (>20 mm), valgus malalignment, increased Q angle, malrotation secondary to internal femoral or external tibial torsion, patella alta, and generalized ligamentous laxity. A detailed history and a thorough physical examination are crucial to clinch an early, accurate diagnosis. Imaging studies play an important role to confirm the clinical diagnosis and also help to identify concomitant intra-articular pathologies. Initially, nonoperative management (including the use of physical therapy, patellar taping or brace) is offered to patients with acute, first-time patellar dislocations and most patients respond well to this mode of treatment. Surgical treatment is indicated for patients who have post-trauma osteochondral fracture or loose body; predisposing anatomical risk factors; recurrent, symptomatic instability; and who have failed an adequate trial of nonoperative management. Surgical treatments include MPFL reconstruction, proximal or distal realignment procedures, and trochleoplasty. Lateral release is often performed in combination with other procedures and seldom performed as an isolated procedure. An individualized case-by-case approach is recommended based on the underlying anatomical risk factors and radiographic abnormality.

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“…In order to eliminate the risk of patellar fracture (that may occur using the patellar tunnel technique), the senior author of this paper (AJS), prefer to use suture anchors to fix the tendon graft to the medial border of the patella. Kurowicki et al [130] have reported the Patella Footprint Technique of MPFL reconstruction. In our Patellofemoral Instability DOI: http://dx.doi.org/10.5772/intechopen.99562 opinion, this surgical technique provides a safe, reliable and reproducible method of restoring patellofemoral stability.…”

Section: Authors' Preferred Treatment Of Mpfl Reconstructionmentioning

confidence: 99%

Patellofemoral Instability

White

¹

,

Sherman²

2016

10

0

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Recurrent patellofemoral instability is a common cause of knee pain and functional disability in adolescent and young adult patients, resulting in loss of time from work and sports. There are numerous factors that contribute to recurrent patellofemoral instability; these factors include tear of the medial patellofemoral ligament (MPFL), weakening or hypoplasia of the vastus medialis obliquus (VMO), trochlear dysplasia, increased tibial tuberosity-trochlear groove (TT-TG) distance (>20 mm), valgus malalignment, increased Q angle, malrotation secondary to internal femoral or external tibial torsion, patella alta, and generalized ligamentous laxity. A detailed history and a thorough physical examination are crucial to clinch an early, accurate diagnosis. Imaging studies play an important role to confirm the clinical diagnosis and also help to identify concomitant intra-articular pathologies. Initially, nonoperative management (including the use of physical therapy, patellar taping or brace) is offered to patients with acute, first-time patellar dislocations and most patients respond well to this mode of treatment. Surgical treatment is indicated for patients who have post-trauma osteochondral fracture or loose body; predisposing anatomical risk factors; recurrent, symptomatic instability; and who have failed an adequate trial of nonoperative management. Surgical treatments include MPFL reconstruction, proximal or distal realignment procedures, and trochleoplasty. Lateral release is often performed in combination with other procedures and seldom performed as an isolated procedure. An individualized case-by-case approach is recommended based on the underlying anatomical risk factors and radiographic abnormality.

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“…Arthroscopic treatment in these patients aims to stabilize the patellofemoral joint and address any osteochondral pathology. 12 , 13 , 14 …”

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confidence: 99%

Use of a Superolateral Portal and 70° Arthroscope to Optimize Visualization of Patellofemoral Tracking and Osteochondral Lesions in Patients With Recurrent Patellar Instability

Bell

¹

,

Jimenez

²

,

Levy

³

et al. 2020

Arthroscopy Techniques

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Surgical treatment of patellofemoral instability and associated cartilaginous lesions can be technically challenging. Visualization of patellar tracking and underlying osteochondral lesions is paramount to operative success. To treat these conditions effectively, a comprehensive arthroscopic assessment of the patellofemoral joint as well as dynamic visualization of patella tracking must be achieved. Visualization of the patellofemoral joint—in particular, the articular cartilage of the patella and trochlea morphology—can be difficult when using traditional anteromedial or anterolateral portals and a 30° arthroscope lens. The technique described here uses an accessory superolateral portal and a 70° arthroscope to achieve significantly improved visualization of the patellofemoral articulation, in particular the chondral surfaces. This vantage point aids the surgeon in effectively evaluating patellar tracking, trochlea morphology, and importantly, osteochondral lesion location to help guide treatment algorithms in the patellofemoral joint.

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Patella Footprint Technique—A Surgical Method for Medial Patellofemoral Ligament Reconstruction

Cited by 3 publications

References 15 publications

Patellofemoral Instability

Patellofemoral Instability

Patellofemoral Instability

Use of a Superolateral Portal and 70° Arthroscope to Optimize Visualization of Patellofemoral Tracking and Osteochondral Lesions in Patients With Recurrent Patellar Instability

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