Implantless patellar fixation in medial patellofemoral ligament reconstruction

Abstract

PurposeThe medial patellofemoral ligament (MPFL) acts as primary restraint to lateral patellar dislocation and its rupture has been reported in almost all cases of acute patellar dislocation. Various surgical techniques have been described for MPFL reconstruction, using many femoral and patellar fixation techniques and different grafts. This article details our technique for MPFL reconstruction using semitendinosus graft which avoids the use of implant at patellar end.MethodsTwenty patients (8 males and 12 females) with complaints regarding acute and chronic lateral patellar instability were evaluated and treated by MPFL reconstruction procedure. The mean age of patients was 21 years (range 17–34 years). MPFL reconstruction was performed using semitendinosus graft passing through two parallel, obliquely directed tunnels created in patella. Fixation of graft was done with an interference screw only at the femoral end. Mean follow-up period after intervention was 26.4 months (range 23–30 months). Results were evaluated using Kujala score.ResultsAll patients gained adequate patellar stability and full arc of motion. No incidence of patella fracture was noted. There were no postoperative complications related to the procedure. There was no recurrence of instability in patella at final follow-up.ConclusionPassing the graft through the tunnels in patella without use of any implant has given excellent functional outcome and moreover has the advantages of less implant-related complications and cost-effectiveness.

Transpatellar bone tunnels perforating the lateral or anterior cortex increase the risk of patellar fracture in MPFL reconstruction: a finite element analysis and survey of the International Patellofemoral Study Group

“…Several different techniques for patellar graft fixation have been reported [7, 15, 21, 29, 30]. A commonly used patellar graft fixation technique requires the creation of transverse patellar bone tunnels for implant‐free patellar MPFL graft fixation [9, 17, 26, 34]. However, patellar bone tunnel techniques for patellar MPFL graft fixation are at increased risk of postoperative patellar fracture [5, 7, 26, 34].…”