Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2013

01-09-2013 | Knee

Anatomical two-bundle medial patellofemoral ligament reconstruction with hardware-free patellar graft fixation: technical note and preliminary results

Authors: Stefan Hinterwimmer, Andreas B. Imhoff, Philipp Minzlaff, Tim Saier, Nikolaus Rosenstiel, Wolfried Hawe, Matthias J. Feucht

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2013

Login to get access

Abstract

Purpose

Various techniques for reconstruction of the medial patellofemoral ligament (MPFL) have been developed. In this article, a modified technique for anatomical two-bundle MPFL reconstruction with hardware-free patellar graft fixation is described and the preliminary results of this technique are presented.

Methods

A modified surgical technique for MPFL reconstruction with a gracilis tendon autograft and hardware-free patellar graft fixation using two short oblique bone tunnels is described in detail. Complications and preliminary results of this procedure were assessed in 19 patients at a mean follow-up of 16 ± 3 months using the Kujala score, Tegner scale, and Insall score.

Results

No postoperative patellar dislocation or subluxation was reported. Eighty-nine per cent of the patients were either satisfied or very satisfied with the overall outcome. The mean Kujala score was 92 ± 7 (range 69–100), and the median Tegner scale was 5 (range 3–7). According to the Insall score, the results of 18 patients (95 %) were rated as good or excellent. Postoperative complications occurred in 3 patients (16 %), with two of them persisting only temporary.

Conclusions

The described technique for anatomical two-bundle MPFL reconstruction is a safe and effective surgical procedure for the treatment of lateral patellar instability, with several methodical advantages compared to similar techniques. Further evaluation in a larger patient cohort with a longer follow-up is necessary to confirm these short-term results.

Level of evidence

IV.
Literature
1.
Ahmad CS, Brown GD, Stein BS (2009) The docking technique for medial patellofemoral ligament reconstruction: surgical technique and clinical outcome. Am J Sports Med 37(10):2021–2027PubMedCrossRef
2.
Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220PubMedCrossRef
3.
Buckens CF, Saris DB (2010) Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med 38(1):181–188PubMedCrossRef
4.
Camanho GL, Bitar AC, Hernandez AJ, Olivi R (2007) Medial patellofemoral ligament reconstruction: a novel technique using the patellar ligament. Arthroscopy 23(1):108 e101–108 e104
5.
Carmont MR, Maffulli N (2007) Medial patellofemoral ligament reconstruction: a new technique. BMC Musculoskelet Disord 8:22PubMedCrossRef
6.
Carr BJ, Ochoa L, Rankin D, Owens BD (2009) Biologic response to orthopedic sutures: a histologic study in a rabbit model. Orthopedics 32(11):828PubMed
7.
Christiansen SE, Jacobsen BW, Lund B, Lind M (2008) Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy 24(1):82–87PubMedCrossRef
8.
9.
Deie M, Ochi M, Adachi N, Shibuya H, Nakamae A (2011) Medial patellofemoral ligament reconstruction fixed with a cylindrical bone plug and a grafted semitendinosus tendon at the original femoral site for recurrent patellar dislocation. Am J Sports Med 39(1):140–145PubMedCrossRef
10.
Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M (2005) A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13(7):522–528PubMedCrossRef
11.
Dejour H, Walch G, Neyret P, Adeleine P (1990) Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot 76(1):45–54PubMed
12.
Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65PubMed
13.
Dhawan A, Ghodadra N, Karas V, Salata MJ, Cole BJ (2012) Complications of bioabsorbable suture anchors in the shoulder. Am J Sports Med 40(6):1424–1430PubMedCrossRef
14.
Ellera Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8(3):335–340PubMedCrossRef
15.
Ellera Gomes JL, Stigler Marczyk LR, de Cesar Cesar P, Jungblut CF (2004) Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study. Arthroscopy 20(2):147–151PubMedCrossRef
16.
Fisher B, Nyland J, Brand E, Curtin B (2010) Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy 26(10):1384–1394PubMedCrossRef
17.
Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81(4):549–557PubMed
18.
Han H, Xia Y, Yun X, Wu M (2011) Anatomical transverse patella double tunnel reconstruction of medial patellofemoral ligament with a hamstring tendon autograft for recurrent patellar dislocation. Arch Orthop Trauma Surg 131(3):343–351PubMedCrossRef
19.
Hapa O, Aksahin E, Ozden R, Pepe M, Yanat AN, Dogramaci Y, Bozdag E, Sunbuloglu E (2012) Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(2):322–326PubMedCrossRef
20.
Hinterwimmer S, Rosenstiel N, Lenich A, Waldt S, Imhoff AB (2012) Femoral osteotomy for patellofemoral instability. Unfallchirurg 115(5):410–416PubMedCrossRef
21.
Howells NR, Barnett AJ, Ahearn N, Ansari A, Eldridge JD (2012) Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br 94(9):1202–1208PubMed
22.
Insall JN, Aglietti P, Tria AJ Jr (1983) Patellar pain and incongruence. II: clinical application. Clin Orthop Relat Res 176:225–232PubMed
23.
Jacobi M, Reischl N, Bergmann M, Bouaicha S, Djonov V, Magnussen RA (2012) Reconstruction of the medial patellofemoral ligament using the adductor magnus tendon: an anatomic study. Arthroscopy 28(1):105–109PubMedCrossRef
24.
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502PubMedCrossRef
25.
Kita K, Horibe S, Toritsuka Y, Nakamura N, Tanaka Y, Yonetani Y, Mae T, Nakata K, Yoshikawa H, Shino K (2012) Effects of medial patellofemoral ligament reconstruction on patellar tracking. Knee Surg Sports Traumatol Arthrosc 20(5):829–837PubMedCrossRef
26.
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163PubMedCrossRef
27.
LeGrand AB, Greis PE, Dobbs RE, Burks RT (2007) MPFL reconstruction. Sports Med Arthrosc 15(2):72–77PubMedCrossRef
28.
Lippacher S, Reichel H, Nelitz M (2010) Patellar fracture after patellar stabilization. Orthopade 39(5):516–518PubMedCrossRef
29.
Matthews JJ, Schranz P (2010) Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop 34(8):1321–1325PubMedCrossRef
30.
Mikashima Y, Kimura M, Kobayashi Y, Miyawaki M, Tomatsu T (2006) Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella. Acta Orthop Belg 72(1):65–71PubMed
31.
Mountney J, Senavongse W, Amis AA, Thomas NP (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br 87(1):36–40PubMed
32.
Nelitz M, Dreyhaupt J, Reichel H, Woelfle J, Lippacher S (2012) Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents with open growth plates: surgical technique and clinical outcome. Am J Sports Med 41(1):58–63PubMedCrossRef
33.
Nomura E, Inoue M (2003) Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Arthroscopy 19(5):E47PubMedCrossRef
34.
Noyes FR, Albright JC (2006) Reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon. Arthroscopy 22(8):904e901–904e907
35.
Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757PubMed
36.
Panni AS, Alam M, Cerciello S, Vasso M, Maffulli N (2011) Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med 39(12):2647–2655PubMedCrossRef
37.
Parikh SN, Wall EJ (2011) Patellar fracture after medial patellofemoral ligament surgery: a report of five cases. J Bone Joint Surg Am 93(17):97e91–97e98CrossRef
38.
Redziniak DE, Diduch DR, Mihalko WM, Fulkerson JP, Novicoff WM, Sheibani-Rad S, Saleh KJ (2009) Patellar instability. J Bone Joint Surg Am 91(9):2264–2275PubMed
39.
Ronga M, Oliva F, Longo UG, Testa V, Capasso G, Maffulli N (2009) Isolated medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 37(9):1735–1742PubMedCrossRef
40.
Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24(1):52–60PubMedCrossRef
41.
Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J (2006) The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13(1):26–31PubMedCrossRef
42.
Schottle P, Schmeling A, Romero J, Weiler A (2009) Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 129(3):305–309PubMedCrossRef
43.
Schottle PB, Fucentese SF, Romero J (2005) Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 13(7):516–521PubMedCrossRef
44.
Schottle PB, Hensler D, Imhoff AB (2010) Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc 18(2):147–151PubMedCrossRef
45.
Schottle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35(5):801–804PubMedCrossRef
46.
Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40(8):1916–1923PubMedCrossRef
47.
Siebold R, Chikale S, Sartory N, Hariri N, Feil S, Passler HH (2010) Hamstring graft fixation in MPFL reconstruction at the patella using a transosseous suture technique. Knee Surg Sports Traumatol Arthrosc 18(11):1542–1544PubMedCrossRef
48.
Sillanpaa PJ, Maenpaa HM, Mattila VM, Visuri T, Pihlajamaki H (2009) A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note. Knee Surg Sports Traumatol Arthrosc 17(5):508–512PubMedCrossRef
49.
Spritzer CE, Courneya DL, Burk DL Jr, Garrett WE, Strong JA (1997) Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. AJR Am J Roentgenol 168(1):117–122PubMedCrossRef
50.
Steensen RN, Dopirak RM, Maurus PB (2005) A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft. Arthroscopy 21(3):365–370PubMedCrossRef
51.
Steensen RN, Dopirak RM, McDonald WG III (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32(6):1509–1513PubMedCrossRef
52.
Strecker W, Keppler P, Gebhard F, Kinzl L (1997) Length and torsion of the lower limb. J Bone Joint Surg Br 79(6):1019–1023PubMedCrossRef
53.
Tanaka MJ, Bollier MJ, Andrish JT, Fulkerson JP, Cosgarea AJ (2012) Complications of medial patellofemoral ligament reconstruction: common technical errors and factors for success: AAOS exhibit selection. J Bone Joint Surg Am 94(12):e87PubMed
54.
Tateishi T, Tsuchiya M, Motosugi N, Asahina S, Ikeda H, Cho S, Muneta T (2011) Graft length change and radiographic assessment of femoral drill hole position for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19(3):400–407PubMedCrossRef
55.
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed
56.
Toritsuka Y, Amano H, Mae T, Uchida R, Hamada M, Ohzono K, Shino K (2011) Dual tunnel medial patellofemoral ligament reconstruction for patients with patellar dislocation using a semitendinosus tendon autograft. Knee 18(4):214–219PubMedCrossRef
Metadata
Title
Anatomical two-bundle medial patellofemoral ligament reconstruction with hardware-free patellar graft fixation: technical note and preliminary results
Authors
Stefan Hinterwimmer
Andreas B. Imhoff
Philipp Minzlaff
Tim Saier
Nikolaus Rosenstiel
Wolfried Hawe
Matthias J. Feucht
Publication date
01-09-2013
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2498-8

Other articles of this Issue 9/2013

Knee Surgery, Sports Traumatology, Arthroscopy 9/2013 Go to the issue

Knee

Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation

Knee

Measurement of lateral plateau depression and lateral plateau widening in a Schatzker type II fracture can predict a lateral meniscal injury

Knee

One-stage bilateral anterior cruciate ligament reconstruction

Shoulder

Translation, cultural adaptation, validity and reliability of the Turkish ASES questionnaire

Shoulder

Pectoralis major transfer for subscapular deficiency: anatomical study of the relationship between the transferred muscle and the musculocutaneous nerve

Knee

Anatomic double-bundle ACL reconstruction restricts knee extension in knees with hyperextension