The adductor magnus tendon is a viable option for medial patellofemoral ligament reconstruction, but with a busy surrounding neurovascular topography

Abstract

PurposeTo describe the proximity of the neurovascular structures surrounding the adductor magnus (ADM), to delineate a safe boundary focusing on the techniques used during graft harvest and to evaluate whether the length of the ADM tendon is sufficient for safe medial patellofemoral ligament (MPFL) reconstruction. MethodsSixteen formalin‐fixed cadavers were dissected. The area surrounding the ADM, the adductor tubercle (AT) and the adductor hiatus was exposed. The following measurements were performed: the (1) total length of MPFL, (2) distance between the AT and the saphenous nerve, (3) the point where the saphenous nerve pierces the vasto‐adductor membrane, (4) the point where the saphenous nerve crosses the ADM tendon, (5) the musculotendinous junction of the ADM tendon, and (6) the point where the vascular structures exit the adductor hiatus. Additionally, (7) the distance between the ADM musculotendinous junction and the nearest vessel (popliteal artery), (8) the distance between the ADM (at the level where the saphenous nerve crosses) and the nearest vessel, (9) the length between the AT and the superior medial genicular artery, and finally (10) the depth between the AT and the superior medial genicular artery were analyzed. ResultsThe in situ length of the native MPFL was 47.6 ± 42.2 mm. The saphenous nerve pierces the vasto‐adductor membrane at a mean distance of 100 mm, although it crosses the ADM itself at an average of 67.6 mm. The vascular structures, on the other hand, become vulnerable at a distance of 89.1 ± 114.0 mm from the AT. After harvesting the ADM tendon, the mean length was found to be 46.9 mm, which was insufficient for fixation. Partial release from the AT resulted in a more adequate length for fixation (65.4 ± 88.7 mm). ConclusionThe adductor magnus tendon is a viable option for the dynamic reconstruction of the MPFL. Knowledge of the surrounding busy neurovascular topography is paramount for a procedure typically performed in a minimally invasive way. The study results are clinically relevant, as they suggest that tendons should be shorter than the minimum distance from the nerve. If in some cases the length of the MPFL is longer than the distance of the ADM from the nerve, the results suggest that a partial dissection of the anatomical structures might be needed. Direct visualization of the harvesting region might be considered in such cases.