A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note

Abstract

Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion.

Results of anatomic gracilis MPFL reconstruction with precise tensioning

“…Over the past few years, multiple techniques [8][9][10][11][12][13][14][15][16][17][18][19] have been described for the management of chronic patellar instability, including MPFL reconstruction, either as an isolated procedure, or combined with distal bone realignment. Several types of graft [3,8,10,11,13,19,20] and various graft fixation techniques [12,15,17] have been evaluated, but there is no scientific evidence to support one technique over another.…”

A “sandwich” method of reconstruction of the medial patellofemoral ligament using a titanium interference screw for patellar instability in skeletally immature patients

“…Letts [12] reported a semitendinosus tenodesis in this way with a resultant recurrence rate of 12 %. Sillanpää [16] reported a new technique for MPFL reconstruction using adductor magnus tendon fixed with two suture anchors. The harvested adductor magnus tendon may not have enough length secondary to anatomical variations.…”

“…There are many reports of corrective procedures for recurrent or habitual dislocation of the patella with an open epiphysis [9][10][11][12], especially MPFL reconstruction [13][14][15][16][17][18]. In skeletally immature patients, there are some difficult problems.…”

Reconstruction of the Medial Patellofemoral Ligament Using the Adductor Magnus Tendon

“…The authors cited 3 clinical studies in which adductor magnus tendon has been used for MPFL reconstruction. [2][3][4] In addition to those, we would like to add one recent article that includes a technical description of MPFL reconstruction with adductor magnus tendon. 5 For graft harvesting, Jacobi et al 1 stated that they prefer a tendon stripper that allows the surgeon to cut the tendon to the desired length.…”