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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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References

  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):2021–2027

    Article  PubMed  Google Scholar 

  2. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220

    Article  PubMed  CAS  Google Scholar 

  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):181–188

    Article  PubMed  Google Scholar 

  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

    Google Scholar 

  5. Carmont MR, Maffulli N (2007) Medial patellofemoral ligament reconstruction: a new technique. BMC Musculoskelet Disord 8:22

    Article  PubMed  Google Scholar 

  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):828

    PubMed  Google Scholar 

  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):82–87

    Article  PubMed  Google Scholar 

  8. Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90(12):2751–2762

    Article  PubMed  Google Scholar 

  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):140–145

    Article  PubMed  Google Scholar 

  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):522–528

    Article  PubMed  Google Scholar 

  11. Dejour H, Walch G, Neyret P, Adeleine P (1990) Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot 76(1):45–54

    PubMed  CAS  Google Scholar 

  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):59–65

    PubMed  CAS  Google Scholar 

  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):1424–1430

    Article  PubMed  Google Scholar 

  14. Ellera Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8(3):335–340

    Article  PubMed  CAS  Google Scholar 

  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):147–151

    Article  PubMed  Google Scholar 

  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):1384–1394

    Article  PubMed  Google Scholar 

  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):549–557

    PubMed  CAS  Google Scholar 

  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):343–351

    Article  PubMed  Google Scholar 

  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):322–326

    Article  PubMed  Google Scholar 

  20. Hinterwimmer S, Rosenstiel N, Lenich A, Waldt S, Imhoff AB (2012) Femoral osteotomy for patellofemoral instability. Unfallchirurg 115(5):410–416

    Article  PubMed  CAS  Google Scholar 

  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):1202–1208

    PubMed  CAS  Google Scholar 

  22. Insall JN, Aglietti P, Tria AJ Jr (1983) Patellar pain and incongruence. II: clinical application. Clin Orthop Relat Res 176:225–232

    PubMed  Google Scholar 

  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):105–109

    Article  PubMed  Google Scholar 

  24. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502

    Article  PubMed  CAS  Google Scholar 

  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):829–837

    Article  PubMed  Google Scholar 

  26. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163

    Article  PubMed  CAS  Google Scholar 

  27. LeGrand AB, Greis PE, Dobbs RE, Burks RT (2007) MPFL reconstruction. Sports Med Arthrosc 15(2):72–77

    Article  PubMed  Google Scholar 

  28. Lippacher S, Reichel H, Nelitz M (2010) Patellar fracture after patellar stabilization. Orthopade 39(5):516–518

    Article  PubMed  CAS  Google Scholar 

  29. Matthews JJ, Schranz P (2010) Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop 34(8):1321–1325

    Article  PubMed  Google Scholar 

  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):65–71

    PubMed  Google Scholar 

  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):36–40

    PubMed  CAS  Google Scholar 

  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):58–63

    Article  PubMed  Google Scholar 

  33. Nomura E, Inoue M (2003) Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Arthroscopy 19(5):E47

    Article  PubMed  Google Scholar 

  34. Noyes FR, Albright JC (2006) Reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon. Arthroscopy 22(8):904e901–904e907

    Google Scholar 

  35. Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757

    PubMed  CAS  Google Scholar 

  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):2647–2655

    Article  PubMed  Google Scholar 

  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):97e91–97e98

    Article  Google Scholar 

  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):2264–2275

    PubMed  Google Scholar 

  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):1735–1742

    Article  PubMed  Google Scholar 

  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):52–60

    Article  PubMed  CAS  Google Scholar 

  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):26–31

    Article  PubMed  Google Scholar 

  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):305–309

    Article  PubMed  Google Scholar 

  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):516–521

    Article  PubMed  CAS  Google Scholar 

  44. Schottle PB, Hensler D, Imhoff AB (2010) Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc 18(2):147–151

    Article  PubMed  Google Scholar 

  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):801–804

    Article  PubMed  Google Scholar 

  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):1916–1923

    Article  PubMed  Google Scholar 

  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):1542–1544

    Article  PubMed  Google Scholar 

  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):508–512

    Article  PubMed  Google Scholar 

  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):117–122

    Article  PubMed  CAS  Google Scholar 

  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):365–370

    Article  PubMed  Google Scholar 

  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):1509–1513

    Article  PubMed  Google Scholar 

  52. Strecker W, Keppler P, Gebhard F, Kinzl L (1997) Length and torsion of the lower limb. J Bone Joint Surg Br 79(6):1019–1023

    Article  PubMed  CAS  Google Scholar 

  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):e87

    PubMed  Google Scholar 

  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):400–407

    Article  PubMed  Google Scholar 

  55. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  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):214–219

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Stefan Hinterwimmer, Andreas B. Imhoff, Philipp Minzlaff, Tim Saier, Nikolaus Rosenstiel & Matthias J. Feucht

  2. Sportsclinic Germany, Ottobrunnerstr. 55, 81737, Munich, Germany

    Stefan Hinterwimmer

  3. Orthopädisches Fachzentrum, Deutenhausener Str. 4, 82362, Weilheim, Germany

    Wolfried Hawe

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  1. Stefan Hinterwimmer
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  2. Andreas B. Imhoff
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Correspondence to Andreas B. Imhoff.

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Hinterwimmer, S., Imhoff, A.B., Minzlaff, P. et al. Anatomical two-bundle medial patellofemoral ligament reconstruction with hardware-free patellar graft fixation: technical note and preliminary results. Knee Surg Sports Traumatol Arthrosc 21, 2147–2154 (2013). https://doi.org/10.1007/s00167-013-2498-8

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