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 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 2/2018

01-06-2018 | Advances in Patellofemoral Surgery (L Redler, Section Editor)

Quadriceps Tendon Autograft Medial Patellofemoral Ligament Reconstruction

Authors: Christian Fink, Robert Steensen, Peter Gföller, Robert Lawton

Published in: Current Reviews in Musculoskeletal Medicine | Issue 2/2018

Login to get access

Abstract

Purpose

Critically evaluate the published literature related to quadriceps tendon (QT) medial patellofemoral ligament (MPFL) reconstruction.

Recent findings

Hamstring tendon (HT) MPFL reconstruction techniques have been shown to successfully restore patella stability, but complications including patella fracture are reported. Quadriceps tendon (QT) reconstruction techniques with an intact graft pedicle on the patella side have the advantage that patella bone tunnel drilling and fixation are no longer needed, reducing risk of patella fracture. Several QT MPFL reconstruction techniques, including minimally invasive surgical (MIS) approaches, have been published with promising clinical results and fewer complications than with HT techniques. Parallel laboratory studies have shown macroscopic anatomy and biomechanical properties of QT are more similar to native MPFL than hamstring (HS) HT, suggesting QT may more accurately restore native joint kinematics.

Summary

Quadriceps tendon MPFL reconstruction, via both open and MIS techniques, have promising clinical results and offer valuable alternatives to HS grafts for primary and revision MPFL reconstruction in both children and adults.
Literature
1.
Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee. 2003;10(3):215–20.CrossRefPubMed
2.
Arendt EA, Moeller A, Agel J. Clinical outcomes of medial patellofemoral ligament repair in recurrent (chronic) lateral patella dislocations. Knee Surg Sports Traumatol Arthrosc. 2011;19(11):1909–14.CrossRefPubMed
3.
Guerrero P, Li X, Patel K, Brown M, Busconi B. Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study. Sports Med Arthrosc Rehabil Ther Technol. 2009;1(1):17.PubMedPubMedCentral
4.
Panni AS, Alam M, Cerciello S, Vasso M, Maffulli N. Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique. Am J Sports Med. 2011;39(12):2647–55.CrossRefPubMed
5.
• Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann CA. Systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2012;40(08):1916–23. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMedPubMedCentral
6.
Dirim B, Haghighi P, Trudell D, Portes G, Resnick D. Medial patellofemoral ligament: cadaveric investigation of anatomy with MRI, MR arthrography, and histologic correlation. AJR Am J Roentgenol. 2008;191(2):490–8.CrossRefPubMed
7.
Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW. Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. AmJ Sports Med. 2011;39(7):1444–9.CrossRef
8.
Seeley M, Bowman KF, Walsh C, Sabb BJ, Vanderhave KL. Magnetic resonance imaging of acute patellar dislocation in children: patterns of injury and risk factors of recurrence. J Pediatr Orthop. 2012;32(2):145–55.CrossRefPubMed
9.
Christiansen SE, Jacobsen BW, Lund B, Lind M. Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy. 2008;24(1):82–7.CrossRefPubMed
10.
Ebied AM, El-Kholy W. Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):926–32.CrossRefPubMed
11.
Fisher B, Nyland J, Brand E, Curtin B. Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy. 2010;26(10):1384–94.CrossRefPubMed
12.
Hapa O, Aksahin E, Ozden R, et al. Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20(2):322–6.CrossRefPubMed
13.
Schoettle PB, Schmeling A, Romero J, Weiler A. Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg. 2009;129(3):305–9.CrossRef
14.
Ochi M, Adachi N, Motoyama M, Atsuo N, Nakamura M, Deie M. MPFL reconstruction for patellar dislocation and subluxation. Arthroscopy. 2012;28(suppl):e416–e417. 3.CrossRef
15.
Matthews JJ, Schranz P. Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop. 2010;34(8):1321–5.CrossRefPubMed
16.
Bollier M, Fulkerson J, Cosgarea A, Tanaka M. Technical failure of medial patellofemoral ligament reconstruction. Arthroscopy. 2011;27(8):1153–9.CrossRefPubMed
17.
• Burks RT, Luker MG, Medial patellofemoral ligament reconstruction techniques in orthopaedics: September 1997. Paper describing surgical techniques, anatomy, or basic science.
18.
•• Steensen RN, Dopirak RM, Maurus PB. A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft. Arthroscopy. 2005;21(3):365–70. Paper describing surgical techniques with clinical results. CrossRefPubMed
19.
• Goyal D. Medial patellofemoral ligament reconstruction: the superficial quad technique. Am J Sports Med. 2013;41:1022–9. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMed
20.
•• Goyal D. “The superficial quad technique” for medial patellofemoral ligament reconstruction: the surgical video technique. Arthrosc Tech. 2015;4(5):e569–75. Paper describing surgical techniques with clinical results. CrossRefPubMedPubMedCentral
21.
• Nelitz M, Williams SR. Anatomic reconstruction of the Medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft. Arthrosc Tech. 2014;3(2):e303–8. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMedPubMedCentral
22.
•• Nelitz M, Dreyhaupt J, Williams SRM. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft shows favourable results at a minimum of 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2017; 1–6. doi:https://​doi.​org/​10.​1007/​s00167-017-4597-4. Paper describing surgical techniques with clinical results.
23.
• Nelitz M, Williams SR. Combined trochleoplasty and medial patellofemoral ligament reconstruction for patellofemoral instability. Oper Orthop Traumatol. 2015;27(6):495–504. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMed
24.
•• Vavalle G, Capozzi M. Isolated reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon. J Orthop Traumatol. 2016;17(2):155–62. Paper describing surgical techniques with clinical results. CrossRefPubMed
25.
• Fink C, Veselko M, Herbort M, Hoser C. Minimally invasive reconstruction of the medial patellofemoral ligament using quadriceps tendon. Arthrosc Tech. 2014;3(3):e325–9. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMedPubMedCentral
26.
•• Fink C, Veselko M, Herbort M, Hoser C. MPFL reconstruction using a quadriceps tendon graft: part 2: operative technique and short term clinical results. Knee. 2014;21(6):1175–9. Paper describing surgical techniques with clinical results. CrossRefPubMed
27.
• Herbort M, Hoser C, Domnick C, et al. MPFL reconstruction using a quadriceps tendon graft. Knee. 2014;21:1169–74. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMed
28.
• Lenschow S, Herbort M, Fink C. Medial patellofemoral ligament reconstruction using quadriceps tendon. Oper Orthop Traumatol. 2015;27(6):474–83. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMed
29.
• Noyes FR, Albright JC. Reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon. Arthroscopy. 2006;22(8):904 e901–7. Paper describing surgical techniques, anatomy, or basic science. CrossRef
30.
•• Leal-Blanquet J, Alentorn-Geli E, Torres-Claramunt R, Monllau JC. Partial quadriceps tendon transfer for revision medial patellofemoral ligament reconstruction: a new surgical technique. Acta Orthop Traumatol Turc. 2017;51(3):258–61. Paper describing surgical techniques with clinical results. CrossRefPubMed
31.
•• Hinckel BB, Gobbi RG, Bonadio MB, Demange K, Pécora JR, Camanho GL. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience. Revista Brasileira de Ortopedia. 2016;51(1):75–82. Paper describing surgical techniques with clinical results. CrossRefPubMedPubMedCentral
32.
• Hinckel BB, Gobbi RG, Demange MK, Bonadio MB, Pécora JR, Camanho GL. Combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and the medial patellotibial ligament with patellar tendon. Arthroscopy Techniques. 2016;5(1):e79–84. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMedPubMedCentral
33.
• Grob K, Manestar M, Filgueira L, Ackland T, Gilbey H, Kuster MS. New insight in the architecture of the quadriceps tendon. J Exp Orthop. 2016;3(1):32. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMedPubMedCentral
34.
Andrikoula S, Tokis A, Vasiliadis H, Georgoulis A. The extensor mechanism of the knee joint: an anatomical study. Knee Surger Sport Traumatol Arthrosc J Article Springer Berlin/Heidelberg. 2006;14:214–20.CrossRef
35.
Iriuchishima T, Shirakura K, Yorifuji H, Fu FH. Anatomical evaluation of the rectus femoris tendon and its related structures. Arch Orthop Trauma Surg. 2012;132:1665–8.CrossRefPubMed
36.
Sonin AH, Fitzgerald SW, Bresler ME, Kirsch MD, Hoff FL, Friedman H. MR imaging appearance of the extensor mechanism of the knee: functional anatomy and injury patterns. Radiographics. 1995;15:367–82.CrossRefPubMed
37.
Warwick R, Williams PL. Gray’s Anatomy 35th British edition, Longman Group Ltd, W.B. Sauders Company Philadelphia; 1973; 562–56.
38.
Yablon CM, Pai D, Dong Q, Jacobson JA. Magnetic resonance imaging of the extensor mechanism. Magn Reson Imaging Clin N Am. 2014;22:601–20.CrossRefPubMed
39.
Last RJ. Some anatomic details of the knee joint. J Bone Joint Surg Br. 1948;30:683–8.CrossRef
40.
Reider B, Marshall JL, Koslin B, Girgis FG. The anterior aspect of the knee joint. J Bone Joint Am. 1981;63:351–6.CrossRef
41.
Clarke HD, Scott WN, Insall JH, Pederson HB, VJ MKRV, et al. Anatomy of the knee. In: Insall JN, Scott WN, editors. Surgery of the knee. Ed 3 ed. Philadelphia: Churchill Livingstone; 2001. p. 13–76.
42.
• Macura M, Veselko M. Simultaneous reconstruction of ruptured anterior cruciate ligament and medial patellofemoral ligament with ipsilateral quadriceps grafts. Arthroscopy. 2010;26(9):1258–62.CrossRefPubMed
43.
Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy. 1993;9:159–63.CrossRefPubMed
44.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10:150–4.CrossRefPubMed
45.
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;(198):43–9.
46.
• Aframian A, Smith TO, Tennent TD, Cobb JP, Hing CB. Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy. Knee Surg Sports Traumatol Arthrosc. 2017;25:3755–72. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMed
47.
• Herbort M, Hoser C, Domnick C, Raschke MJ, Lenschow S, Weimann A, et al. MPFL reconstruction using a quadriceps tendon graft. part 1: biomechanical properties of quadriceps tendon MPFL reconstruction in comparison to the intact MPFL. A human cadaveric study. Knee. 2014;21(6):1169–74. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMed
48.
• Lenschow S, Schliemann B, Gestring J, Herbort M, Schulze M, Kösters C. Medial patellofemoral ligament reconstruction: fixation strength of 5 different techniques for graft fixation at the patella. Arthroscopy. 2013;29(4):766–73. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMed
49.
• Lippe J, Armstrong A, Fulkerson JP. Anatomic guidelines for harvesting a quadriceps free tendon autograft for anterior cruciate ligament reconstruction. Arthroscopy. 2012;28(7):980–4. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMed
50.
• Xerogeanes JW, Mitchell PM, Karasev PA, Kolesov IA, Romine SE. Anatomic and morphological evaluation of the quadriceps tendon using 3-dimensional magnetic resonance imaging reconstruction: applications for anterior cruciate ligament autograft choice and procurement. Am J Sports Med. 2013;41(10):2392–9. Paper describing surgical techniques, anatomy, or basic science. CrossRefPubMed
Metadata
Title
Quadriceps Tendon Autograft Medial Patellofemoral Ligament Reconstruction
Authors
Christian Fink
Robert Steensen
Peter Gföller
Robert Lawton
Publication date
01-06-2018
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 2/2018
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-018-9476-1

Other articles of this Issue 2/2018

Current Reviews in Musculoskeletal Medicine 2/2018 Go to the issue

Advances in Patellofemoral Surgery (L Redler, Section Editor)

Predicting Risk of Recurrent Patellar Dislocation

PCL Update (K Jones and M Alaia, section editors)

Arthroscopic Transtibial PCL Reconstruction: Surgical Technique and Clinical Outcomes

Advances in Patellofemoral Surgery (L Redler, Section Editor)

Patellofemoral Cartilage Repair

Advances in Patellofemoral Surgery (L Redler, Section Editor)

Advances in Patellofemoral Arthroplasty

PCL Update (K Jones and M Alaia, section editors)

Revision PCL Reconstruction Review/Update

Advances in Patellofemoral Surgery (L Redler, Section Editor)

Use of TT-PCL versus TT-TG