Lateral Patellofemoral Ligament Reconstruction Using a Quadriceps Tendon Graft

Saper, Michael G.; Shneider, David A.

doi:10.1016/j.eats.2014.04.007

Cited by 17 publications

(14 citation statements)

References 17 publications

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“…Medial patellar instability is a recognized problem in patients with anterior knee pain. 12 , 18 – 20 , 22 Most commonly, this has been reported as an iatrogenic consequence of lateral retinacular release, which inadvertently transects the ligamentous structures, at least of the deep layers. 7 , 12 Kaplan 10 first described the anatomic characteristics of the lateral side of the knee and identified a lateral epicondylopatellar ligament running at the level of the deep transverse retinaculum.…”

Section: Discussionmentioning

confidence: 99%

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Lateral Patellofemoral Ligament: An Anatomic Study

Shah

DeFroda

Ware

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Medial instability of the patellofemoral joint is a rare but known phenomenon that may result from an incompetent lateral patellofemoral ligament (LPFL). Surgical reconstruction of the LPFL has been described. However, anatomic details of the ligament have not been the subject of scrutiny.Purpose:To describe the anatomic origin and insertion of the LPFL.Study Design:Descriptive laboratory study.Methods:Ten fresh-frozen, unpaired human cadaveric knees (mean age, 57 years) were dissected to identify the LPFL. The dissection was carried out by elevating the iliotibial band to expose the deep capsular layer of the knee joint, followed by a medial parapatellar approach to the knee. Then the quadriceps and patellar tendons were sectioned, and the LPFL was isolated by visualization and palpation. The LPFL was dissected to reveal its origin and insertion; these were measured with respect to the lateral epicondyle and the superior-inferior axis of the lateral patella, respectively.Results:On average, the LPFL had a variable point of origin in location as well as width about the lateral epicondyle. The LPFL originated, on average, 2.6 mm distal (range, 13.1 mm proximal to 11.4 mm distal) and 10.8 mm anterior (range, 7.3 mm posterior to 14.9 mm anterior) to the lateral epicondyle. The LPFL insertion on the patella was more reliably found to be about 45% (range, 23.7%-58.4%) of its lateral articular surface. The insertion on the patella was found to be in the middle third of the lateral patella.Conclusion:The LPFL has an origin that is variable but, on average, was found to be distal and anterior to the lateral epicondyle. The patella insertion was more reliably found to be in the middle third of the lateral patella. These anatomic relationships can help the surgeon reconstruct the LPFL in a more anatomic fashion.Clinical Relevance:Surgeons who are tasked with reconstruction of the LPFL of a patient with idiopathic medial instability or a previous aggressive lateral release of the knee may reference this article to perform an anatomic reconstruction of the LPFL. We hope that having anatomic landmarks for the reconstruction of this ligament permits the surgeon to operate in an efficient manner that allows for the optimal outcome. This is a rare surgical issue, and no studies are available that provide this information. The little information present in the literature does not provide measurements for anatomic reconstruction; rather, it is limited to descriptions of reconstruction techniques that indirectly provide stability on the lateral aspect of the knee.

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Section: Discussionmentioning

confidence: 99%

“…Some authors have suggested imbricating the lateral retinaculum to prevent subluxation, 9 , 15 others advocate soft tissue augmentation using the fascia lata, 1 and some describe a variety of reconstruction methods using autograft and allograft. 3 , 19 , 23 , 24 …”

mentioning

confidence: 99%

Lateral Patellofemoral Ligament: An Anatomic Study

Shah

DeFroda

Ware

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Many surgical techniques have been described to treat medial patellar instability, using the iliotibial band, patellar tendon, quadriceps tendon with a bone block, or gracilis tendon as a graft. [6][7][8][10][11][12][13] Some individuals have a lateral epicondylopatellar ligament, to a varying degree of frequency, but the superficial oblique and deep transverse retinacular layers are found more consistently. 1 The superficial oblique retinaculum is quite thin.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13] Reconstructive surgery includes direct ligament repairs 5,9 or reconstructions of the lateral patellofemoral ligament or lateral retinaculum. [6][7][8][10][11][12][13] According to Teitge and Torga Spak, 7 medial patellar instability reappears after the first postoperative year after lateral retinacular repair and imbrication. Given that the literature regarding surgical treatment offers only Level IV or V evidence, the surgical therapeutic approach should be based on the surgeon's common sense, personal experience, and criteria.…”

Section: Discussionmentioning

confidence: 99%

Deep Transverse Lateral Retinaculum Reconstruction for Medial Patellar Instability

Sanchis-Alfonso¹,

Montesinos-Berry²,

Monllau

et al. 2015

Arthroscopy Techniques

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Medial patellar instability can be a disabling complication of an extensive lateral retinaculum release. It is often overlooked, and for the diagnosis, it is necessary to have a high index of suspicion. Typically, the patient feels a new pain and new instability after the lateral retinaculum release that are distinct from, and much worse than, those before surgery. All of our patients had significant relief from their pain with "reverse" McConnell taping. If there is a significant improvement in symptoms after this taping and stress radiographs or stress axial computed tomography scans show an objective pathologic medial patellar displacement, reconstruction of the lateral retinaculum should be considered. This article details our technique for reconstruction of the deep transverse layer of the lateral retinaculum using an anterior strip of the iliotibial band. This strip is detached from its insertion onto the Gerdy tubercle and then reflected proximally beyond the level of the lateral femoral epicondyle. Finally, it is attached either by direct suture to the remaining prepatellar and peripatellar retinaculum if there is adequate tissue present or by a suture anchor.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Despite the initial study by Hughston and Deese 2 in 1988 and other studies that followed, all of which warned about IMPI, and despite articles written later about avoiding this injury, the problem still exists currently. [8][9][10][11][12][13] Almost all IMPI cases have been caused either by improper patient selection or by overzealous and excessive release of the lateral retinaculum (LR). 1 All too often, the pain and disability from IMPI are much worse than the preoperative symptoms for which the operation was performed, causing serious psychological side effects.…”

mentioning

confidence: 98%