Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents Using a Pedicled Quadriceps Tendon Graft

Abstract

Reconstruction of the medial patellofemoral ligament (MPFL) has recently become a popular procedure for children and adolescents with patellofemoral instability. Nevertheless, high complication rates of up to 26% have been reported. The traditionally used technique requires patellar bone tunnels that may place the proportionately smaller patella at higher risk of fracture. Because of the adjacent physis of the femoral insertion, anatomic reconstruction of the MPFL has the risk of injury to the growth plate. This technical report therefore presents a technique for anatomic reconstruction of the MPFL in a skeletally immature population using a pedicled superficial quadriceps tendon graft, hardware-free patellar graft attachment, and anatomic femoral fixation distal to the femoral physis. The advantages of this technique include avoidance of bony patellar complications, an anatomically truer reconstruction, a single incision, and sparing of the hamstring tendons for reconstruction of any future ligamentous injuries.

Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome

“…Harvesting of the graft then continued distally to a point over the proximal patellar third. The superficial slip of the quadriceps tendon inserts into the anterior portion of the base and the superior third of the anterior surface of the patella [21]. Care was taken not to accidentally divide the graft at its inferior attachment to the patella during dissection.…”

“…The initial superficial vertical incision of the tendon was made 2 to 3 cm proximal to the superior patellar pole because the superficial slip of the tendon is easiest to differentiate at this level [21]. In addition, this incision was made 2 to 4 mm lateral to the border of the vastus medialis, thus preserving a thin strip of the medial tendon (Fig.…”

“…4a). The second vertical incision was made into the tendon approximately 12 to 15 mm lateral to the first, thus determining the width of the graft [21].…”

Medial Patellofemoral Ligament Reconstruction and Nonanatomic Stabilization Techniques in Skeletally Immature Patients

“…2 nonabsorbable, braided sutures; and (2) to the adductor magnus tendon. 27 Nelitz et al 28,29 (►Fig. 3C) described a similar pedicled quadriceps technique.…”

“…The graft was then secured to the patella with subperiosteal braided resorbable suture. 28,29 Pedicled Hamstring Tendons Graft Historically, Galeazzi 30 (►Fig. 4A) in 1922 described one of the first pedicled hamstring reconstruction.…”