Skip to main content
SpringerLink
Log in

A minimally invasive medial patellofemoral ligament arthroscopic reconstruction

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

The medial patellofemoral ligament reconstruction is recognized as a good choice for patients with recurrent patellar dislocation. Most techniques of the medial patellofemoral ligament reconstruction are open surgeries. Recently, we present a minimally invasive medial patellofemoral ligament arthroscopic reconstruction technique as a possible alternative method for recurrent patellar dislocation. The aim of the study was to describe a safe and effective technique to perform medial patellofemoral ligament reconstruction. The graft was prepared in shape to “Y.” Two 5-mm incisions were made in the skin above the medial edge of the patella. Two docking bone tunnels were drilled from medial edge to the center of the patella, mimicking the wide patellar insertion of the medial patellofemoral ligament, and a bone tunnel was made at the femoral insertion site. Two free ends of the graft were fixed into the patellar tunnels by lateral cortical suspension, and the folded end was fixed into the femoral tunnel by bioabsorbable interference screw. Average patellar tilt and the congruence angle were 30.7° ± 7.5° and 52.7° ± 7.3° and were reduced to 12.8° ± 0.9° and 2.3° ± 11.5° after treatment. The Kujala score was increased from 63.0 ± 9.0 to 91.0 ± 7.0. The minimally invasive medial patellofemoral ligament arthroscopic reconstruction in this paper seems to be helpful to increase safe of operation and treatment effect and reduce complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Avikainen VJ, Nikku RK, Seppänen-Lehmonen TK (1993) Adductor magnus tenodesis for patellar dislocation: technique and preliminary results. Clin Orthop Relat Res 297:12–16

    PubMed  Google Scholar 

  2. Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11:24–31

    CAS  PubMed  Google Scholar 

  3. Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693

    CAS  PubMed  Google Scholar 

  4. Desio SM, Burks RT, Bachus KN (1988) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65

    Google Scholar 

  5. Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 349:174–182

    Article  PubMed  Google Scholar 

  6. Balcarek P, Ammon J, Frosch S, Walde TA, Schüttrumpf JP, Ferlemann KG, Lill H, Stürmer KM, Frosch KH (2010) Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy 26:926–935

    Article  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 24:82–87

    Article  PubMed  Google Scholar 

  8. 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 13:522–528

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  10. Nomura E, Inoue M, Osada N (2005) Augmented repair of avulsion-tear type medial patellofemoral ligament injury in acute patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13:346–351

    Article  PubMed  Google Scholar 

  11. Steensen RN, Dopirak RM, Maurus PB (2005) A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft. Arthroscopy 21:365–370

    Article  PubMed  Google Scholar 

  12. Dejour D, Reynaud P, Lecoultre B (1998) Douleurs et instabilite rotulienne. Essai de classification. Med Hyg (Geneve) 56:1466–1471

    Google Scholar 

  13. Boden BP, Pearsall AW, Garrett WE Jr, Feagin JA Jr (1997) Patellofemoral instability: evaluation and management. J Am Acad Orthop Surg 1:47–57

    Google Scholar 

  14. Beaconsfield T, Pintore E, Maffulli N, Petri GJ (1994) Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res 308:18–28

    PubMed  Google Scholar 

  15. Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104

    CAS  PubMed  Google Scholar 

  16. Hvid I, Andersen LI, Schmidt H (1981) Chondromalacia patellae. The relation to abnormal patellofemoral joint mechanics. Acta Orthop Scand 52(6):661–666

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  19. Kang HJ, Wang F, Chen BC, Su YL, Zhang ZC, Yan CB (2010) Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 18:1511–1516

    Article  PubMed  Google Scholar 

  20. Fithian Donald, Khan Najeeb (2010) Medial patellofemoral ligament reconstruction. Op Tech Sports Med 18:93–97

    Article  Google Scholar 

  21. Farr J, Schepsis AA (2006) Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. J Knee Surg 19:307–316

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  23. Thaunat M, Erasmus PJ (2007) The favourable anisometry: an original concept for medial patellofemoral ligament reconstruction. Knee 14:424–428

    Article  PubMed  Google Scholar 

  24. 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 18:214–219

    Article  PubMed  Google Scholar 

  25. 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 87:36–40

    CAS  PubMed  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  27. 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 

  28. Boselli KJ, Bowers AL, Shubin Stein BE, Ahmad CS (2010) Medial patellofemoral ligament reconstruction: docking technique. Op Techn Sports Med 18(2):98–106

    Article  Google Scholar 

  29. Siebold R, Borbon CA (2012) Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft-surgical technique. Knee Surg Sports Traumatol Arthrosc 20(7):1245–1251

    Article  PubMed  Google Scholar 

  30. Scapinelli R (1967) Blood supply of the human patella. Its relation to ischaemic necrosis after fracture. J Bone Joint Surg Br 49(3):563–570

    CAS  PubMed  Google Scholar 

  31. Drez D Jr, Edwards TB, Williams CS (2001) Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 17(3):298–306

    Article  PubMed  Google Scholar 

  32. Schöttle 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  Google Scholar 

  33. Weiler A, Hoffmann RF, Stähelin AC, Bail HJ, Siepe CJ, Südkamp NP (1998) Hamstring tendon fixation using interference screws: a biomechanical study in calf tibial bone. Arthroscopy 14(1):29–37

    Article  CAS  PubMed  Google Scholar 

  34. Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S (1991) Tensile properties of the human femur-anterior cruciate ligament-tibia complex: the effects of specimen age and orientation. Am J Sports Med 19(3):217–225

    Article  CAS  PubMed  Google Scholar 

  35. Buelow JU, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10(2):80–85

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Jian-Wei Zhou, Cheng-Hai Wang, Gang Ji, Long-Fei Ma, Juan Wang, Jiang-Tao Dong & Fei Wang

  2. Department of Rehabilitation, Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China

    Feng Zhang

Authors
  1. Jian-Wei Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cheng-Hai Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gang Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Long-Fei Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Feng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jiang-Tao Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fei Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhou, JW., Wang, CH., Ji, G. et al. A minimally invasive medial patellofemoral ligament arthroscopic reconstruction. Eur J Orthop Surg Traumatol 24, 225–230 (2014). https://doi.org/10.1007/s00590-012-1162-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-012-1162-1

Keywords

Search

Navigation