Medial Quadriceps Tendon Femoral Ligament Reconstruction Technique and Surgical Anatomy

Joseph, Sheeba M.; Fulkerson, John P.

doi:10.1016/j.eats.2018.09.002

Cited by 33 publications

(21 citation statements)

References 23 publications

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“…A secondary finding was the identification and agreement of the broad attachment of the MPFL on the patella site between dissection and MRI. The rate of its insertion in the quadriceps was in accordance with most recent studies and reviews in the international literature [16][17][18]. Additionally, there was confirmation of the consistency of MPFL shape.…”

Section: Discussionsupporting

confidence: 88%

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Surgical and Radiological Anatomy of the Medial Patellofemoral Ligament: A Magnetic Resonance Imaging and Cadaveric Study

et al. 2021

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The purpose of this study was to compare the measurement of several anatomical features of the medial patellofemoral ligament (MPFL) between magnetic resonance imaging (MRI) and by direct fashion during dissection. We hypothesized that the measurements between these two techniques would agree. MRI of 30 fresh-frozen cadaveric knees was followed by dissection. MPFL patella and femoral attachment were evaluated; their shape, length, and width were measured; and measurements were compared. MRI was deemed unreliable for the determination of several of the aforementioned anatomical features. Important findings include: (a) observations on MPFL attachment at medial patella side and attachment to quadriceps were identical between dissection and MRI; (b) average width at patella insertion was significantly different between the two methods (p = 0.002); and (c) an attachment to the quadriceps tendon was present in 20/30 specimens and d. detailed measurements of a thin, non-linear, and three-dimensional structure, such as the MPFL, cannot be performed on MRI, due to technical difficulties. This anatomical radiological study highlights the shape, anatomical measurements (length and width), and attachment of the MPFL using a relatively large cadaveric sample and suggests that MRI is not reliable for detailed imaging of its three-dimensional anatomy.

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Section: Discussionsupporting

confidence: 88%

“…This was also confirmed during the MR measurements. Previously, Fulkerson and Edgar presented these fibers of the MPFL as a distinct ligament, the "medial quadriceps tendon femoral ligament" [17]. This term describes the specific fibers that attach to the quadriceps tendon.…”

Section: Discussionmentioning

confidence: 99%

Surgical and Radiological Anatomy of the Medial Patellofemoral Ligament: A Magnetic Resonance Imaging and Cadaveric Study

et al. 2021

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“…Different approaches have been described for performing an MPFL reconstruction in skeletally immature patients to protect the growth plates, such as moving the femoral tunnel distally or using a soft tissue–based approach (medial quadriceps tendon femoral reconstruction). 11 , 12 , 13 In patients with recurrent instability and significant patella alta (Caton Deschamps Index [CDI] > 1.4). 14 a concomitant distalization or shortening procedure in addition to MPFL reconstruction may be necessary to correct this pathoanatomy and decrease the risk of subsequent failure.…”

mentioning

confidence: 99%

Patellar Tendon Shortening for Treatment of Patella Alta in Skeletally Immature Patients With Patellar Instability

Parvaresh

Huddleston

Yanke

2021

Arthroscopy Techniques

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Aberrant anatomy, such as patella alta, can be a risk factor for recurrent patellar instability or inferior clinical outcomes after medial patellofemoral ligament reconstruction. In patients with significant patella alta (Caton Deschamps Index >1.2), tibial tubercle distalization may be considered to improve outcomes. However, despite patellar instability commonly affecting pediatric patients, a distalization osteotomy is not feasible in this patient population due to the presence of open physes. Our article presents a technique describing an alternative soft-tissue distalization approach whereby patellar height is decreased by shortening the patellar tendon.

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“…9,12 Using an algorithm-based approach, similar results of MPFL-R and MPFL repair were found (level II evidence). 13 Recognition of roles of other medial soft-tissue stabilizers such as MQTFL, medial patellotibial (MPTL) and patellomeniscal (MPML) ligaments has led to the development of procedures that can be used in isolation, as well as in combination with MPFL-R. 14,15 In view of the above-mentioned concerns associated with MPFL reconstruction and the encouraging results of other soft-tissue procedures, we propose a technique of MPFC advancement (MPFL and MQTFL combined) on to the patella that is very simple to perform and addresses the basic pathology of insufficient proximal medial patellar restraints while retaining its dynamic nature.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Medial Patellofemoral Complex Advancement for Recurrent Lateral Patellar Instability and Selective Acute Primary Patellar Dislocations

Jha

Jain

2021

Arthroscopy Techniques

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Medial patellofemoral complex (MPFC) is considered as the primary medial patellar restraint and has a static, as well as dynamic, component. MPFL reconstruction (MPFL-R) restores only the static component of MPFC, is associated with multiple technical concerns, and has a steep learning curve. Need for physeal sparing techniques and relatively high rates of complications including patella fracture are some other concerns with MPFL-R. We propose a simple procedure for advancement of MPFC onto patella, which is indicated in most of the recurrent lateral instabilities (with a positive lateral glide test result and an intact MPFL on magnetic resonance imaging). The procedure is also indicated in selective acute primary dislocationsdthose with associated chondral lesions and magnetic resonance imagingedocumented isolated patellar side avulsion/injury. MPFC advancement is a more anatomical procedure that also restores dynamic medial checkrein of patella and can be performed even by a novice surgeon. MPFC advancement is devoid of the multiple technicalities of MPFL-R, does not require intraoperative imaging or any postoperative immobilization, and renders complications like donor graft-site morbidity and patella fractures irrelevant. It requires no modifications in patients with open physes and can be performed in isolation or with other procedures as per à la carte principle.

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Medial Quadriceps Tendon Femoral Ligament Reconstruction Technique and Surgical Anatomy

Cited by 33 publications

References 23 publications

Surgical and Radiological Anatomy of the Medial Patellofemoral Ligament: A Magnetic Resonance Imaging and Cadaveric Study

Surgical and Radiological Anatomy of the Medial Patellofemoral Ligament: A Magnetic Resonance Imaging and Cadaveric Study

Patellar Tendon Shortening for Treatment of Patella Alta in Skeletally Immature Patients With Patellar Instability

Medial Patellofemoral Complex Advancement for Recurrent Lateral Patellar Instability and Selective Acute Primary Patellar Dislocations

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