Medial Patellofemoral Ligament Reconstruction Using a Modified “Reverse-Loop” Technique

Abstract

Medial patellofemoral ligament reconstruction is a commonly performed procedure for patellofemoral instability. In recent years the surgery has evolved considerably as the anatomy and goals of reconstruction have become more defined. This has resulted in numerous surgical options involving various fixation devices. Furthermore, as biomechanical data accumulate regarding the importance of graft position and tension, surgical techniques for applying this knowledge with precision are needed. This technical note with an accompanying video details one such technique that may be applied to various methods of fixation, allowing for improved precision and possibly resulting in a stronger fixation construct.

Dynamic tracking influenced by anatomy following medial patellofemoral ligament reconstruction: Computational simulation

“…The grafts wrapped around the medial femoral condyle, with the portion from the femoral attachment to the wrapping surface rigid. A common graft tensioning technique that allows one quadrant of patellar lateral translation with the knee passively flexed to 30° was simulated [37, 38]. The resting length of the graft was set with the patella displaced 10 mm laterally from the deepest point of the trochlear groove (range of patellar width: 36 to 43.5 mm).…”

The double-pulley technique for anatomical double-bundled medial patellofemoral ligament reconstruction

“…_ 2 ) T D $ F I G ] Among all the different double-bundled MPFL reconstruction procedures described in the literature so far, majority of them vary in the methods of patellar fixation, which can be categorised into looping though bone-tunnels [24][25][26], partial bone drilling with aperture interference screw fixation with interference [27][28][29][30], and patellar rim fixation with suture anchors [31][32][33][34]. Among them, we believe patellar rim fixation with suture anchors theoretically offers the most advantages than the bone-tunnel and interference screw fixation techniques.…”

Medial Patellofemoral Ligament Reconstruction: A Surgical Technique to Dynamically Control Graft Tension

“…Other authors have also described an adjustable “reverse loop” technique where a double loaded anchor is unloaded, and a loop is created which the patellar side of the graft can be passed through and re-tensioned as needed after evaluation of patellar tracking and graft tension. 12 However, this requires anchor preparation before implantation, potentially increasing operative time.…”