Small (3.2-mm), Short, Oblique Patellar Tunnels for Patellar Fixation in MPFL Reconstruction

Abstract

Multiple techniques exist for patellar graft fixation during medial patellofemoral ligament (MPFL) reconstruction, each with their respective advantages and disadvantages. In recent studies, the use of 2 small (3.2-mm), short, oblique patellar tunnels with looped graft has been shown to be effective for patellar fixation during MPFL reconstruction. This technique does not appear to be associated with the same risk of patellar fracture as the use of larger (4.5-mm) transpatellar tunnels. A recent retrospective study also reported decreased risk of recurrent patellar instability and decreased cost compared with the use of suture anchors for patellar fixation, which is currently the most common modality. Given these promising findings relative to existing techniques for patellar fixation, further description of the senior author’s technique for using these small (3.2-mm), short, oblique patellar tunnels is provided. This technique is safe, efficacious, and cost-conscious and should be considered a viable option for patellar fixation during MPFL reconstruction.

Lateral Opening Wedge Distal Femur Osteotomy and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability

“…Perforating vessels are ligated carefully and adequate exposure is obtained for eventual osteotomy and lateral plate fixation. Next, an MPFL-R is begun utilizing the technique described by Moran et al 3 The entirety of the MPFL-R is outside the scope of this technical article, but relevant points about performing this procedure concomitantly with a DFO will be highlighted .…”

Hybrid 2-Point Suture Anchor Technique for Patellar Fixation in Medial Patellofemoral Ligament Reconstruction

“…Furthermore, any intra-articular pathology or loose bodies can be noted and treated prior to proceeding with the open procedure. 14 After visualization of the joint space arthroscopically, a 3-to 4-cm longitudinal incision is made over the superior border of the patella, and dissection is performed past layers 1 and 2. By use of a 2.4-mm drill bit, the proximal anchor is placed at the superior one-third of the proximal patella.…”

“…Furthermore, any intra-articular pathology or loose bodies can be noted and treated prior to proceeding with the open procedure. 14 …”

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

“…However, according to procedures, graft choices, and xation methods in MPFL reconstruction, there is no gold standard. [14][15]20] According to the reconstruction of MPFL, graft choice is of fundamental importance. The graft can be harvested from several donors, either autograft, allograft, or synthetic graft.…”