Patellar dislocation in skeletally immature patients: semitendinosous and gracilis augmentation for combined medial patellofemoral and medial patellotibial ligament reconstruction

Giordano, Marco; Falciglia, Francesco; Aulisa, Angelo Gabriele; Guzzanti, Vincenzo

doi:10.1007/s00167-011-1784-6

Cited by 51 publications

(55 citation statements)

References 20 publications

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“…The MPFL injury occurred in up to 78.4-94% in children and adolescents after acute LPD [3,4,6,8]. Injury to the MPFL may reduce passive stability and predict subsequent instability with non-operative treatment, and these have led to an increase in initial management by operative repair or reconstruction of the MPFL [15,[30][31][32][33][34][35]. However, the main rupture location of the MPFL in the case of LPD in children and adolescents remains debatable.…”

Section: Discussionmentioning

confidence: 99%

Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in children and adolescents: An MRI evaluation

Zheng

Shi

Feng

et al. 2015

Injury

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Section: Discussionmentioning

confidence: 99%

Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in children and adolescents: An MRI evaluation

Zheng

Shi

Feng

et al. 2015

Injury

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“…We present a simple technique for the combined MPFL and MPTL reconstruction in skeletally immature patients, ensuring reconstruction and stabilization of the patella with no other associated procedures, such as trochleoplasty or medialization of the anterior tibial tuberosity through osteotomy. The gracilis tendon is used as graft because of its length, making it possible to preserve its tibial insertion (14).…”

Section: Discussionmentioning

confidence: 99%

“…Several techniques have been described (13) to control patellar instability. Many of these are employed in patients with skeletal immaturity, high riding patella, trochlear dysplasia, and ligament hyperlaxity (14). They vary in terms of graft choice, type of fixation, patellar and femoral attachments and graft tension at the time of fixation (13,(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Combined reconstruction of the medial patellotibial and patellofemoral ligaments

Maffulli

Aicale

Tarantino

et al. 2019

Muscle Ligaments and Tendons J

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Background. Patellofemoral instability is commonly associated with the rupture of the medial patellofemoral ligament (MPFL), and the role of the medial patellotibial ligament (MPTL) is slowly emerging. Soft tissue reconstructions are able to restore patellar stability. Methods. We present a surgical technique for the combined reconstruction of the MPFL and MPTL using gracilis or semitendinosus tendon (ST) autograft and two patellar tunnels, looping the free end of the tendon graft around the adductor magnus tendon. Results. In this surgical technique the femoral physeal plate is not affected, no femoral tunnel needs to be drilled, no hardware is needed to fix the graft to the bone. Conclusion. The technique described is simple, safe, inexpensive, reproducible and does not require intraoperative fluoroscopy.

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“…[13][14][15][16][17] The only difference in our proposed procedure involves the grafts used. The use of the quadricipital and patellar grafts for the reconstruction of the MPFL is already well-known and widespread, and the use of the patellar tendon for isolated reconstruction of the MPTL has also been described.…”

Section: Discussionmentioning

confidence: 99%

“…Some reports in the literature have described case series of combined MPFL and MPTL reconstructions, mostly in children, with good results. [13][14][15][16][17] These reconstructions use the semitendinosus or gracilis tendons with preservation of their tibial insertions, which does not coincide with the anatomic insertion of the MPTL. Reconstruction of the MPTL with the patellar tendon associated with procedures other than MPFL reconstruction (lateral retinacular lengthening, vastus medialis obliquus advancement, medial retinaculum closure, and tibial tuberosity osteotomy) has also been described with good outcomes.…”

mentioning

confidence: 99%

Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Hinckel

Gobbi

Demange

et al. 2016

Arthroscopy Techniques

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Although the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts.L ateral patellar dislocation is responsible for 2% to 3% of all knee injuries and is the second leading cause of hemarthrosis. 1,2 The medial ligaments responsible for maintaining the stability of the patellofemoral joint are the medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), and medial patellomeniscal ligament (MPML).There are several studies on the MPFL and its anatomic and biomechanical characteristics 2-6 ; however, little is known about the MPTL and MPML. 2,3,5,6 The first biomechanical studies showed that the MPFL contributes 50% to 60% to medial restriction during initial flexion (between 0 and 30 of flexion). [4][5][6] The contribution of the secondary restrictors varies among those studies, ranging from 0% to 24% for the MPTL and from 8% to 38% for the MPML. 3,5,6 However, in a more recent study, Philippot et al. 2 evaluated the medial ligaments in higher degrees of flexion (from 0 to 90 of flexion), showing that the contributions of the MPTL and MPML to lateral translation restriction increase from 26% in extension to 46% at 90 of flexion. In addition, the influences of the MPTL and MPML at 90 of flexion were 72% in patellar tilt and 92% in patellar rotation. 2 In the study by Philippot et al., the combined importance of the MPTL and MPML was evaluated rather than the isolated actions of each of these ligaments. In a clinical study, Garth et al. 7 observed the presence of clinical and arthroscopic subluxation in patients with isolated MPML lesions with the knee in extension. Thus the MPTL and MPML are important in maintaining normal kinematics of the patellofemoral joint in all ranges of motion, especially at extension and higher degrees of flexion.Usually, surgical treatment involves a combination of reconstruction of the injured MPFL and adjuvant procedures for better alignment and congruence of the patellofemoral joint. Several types of grafts have been described for the reconstruction of the MPFL, and they have shown good results. [8][9][10] In a systematic review of the complications associated with exclusive reconstruction of the MPFL, the observed complication rate was 26.1% of cases. Clinical failure presenting with persistence of

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Patellar dislocation in skeletally immature patients: semitendinosous and gracilis augmentation for combined medial patellofemoral and medial patellotibial ligament reconstruction

Abstract: Expert opinion, Level V.

Cited by 51 publications

References 20 publications

Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in children and adolescents: An MRI evaluation

Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in children and adolescents: An MRI evaluation

Combined reconstruction of the medial patellotibial and patellofemoral ligaments

Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

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