Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability

Ebied, Ayman M; Elkholy, Wael Badr

doi:10.1007/s00167-011-1659-x

Cited by 44 publications

(61 citation statements)

References 21 publications

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“…The statistical verification of our hypothesis leads to the conclusion that the MR plays an important role as a medial stabiliser of the patella, especially in low angles of flexion, since from 20 o to 90 o of knee flexion, the interaction of bones is an additional contribution to the stability of the patella, which is in concordance with the literature [6,13]. The MPFL and MPML are major stabilisers, contributing up to 50-60% and 24%, respectively, while MR and MPTL contributes up to 13% [5,13]. VMO also plays an important role, especially in the first 20-30 o of flexion, due to the meshing of its fibres to MPFL, reinforcing MPFLs stabilising role [13].…”

Section: Discussionsupporting

confidence: 88%

“…In most studies the outcomes were positive, showing that the MR plays an important role as a stabilising factor for the patella. There have also been studies comparing methods of MR repair and repair of other medial stabilisers, such as the vastus medialis [20] and MPFL [21], showing that MPFL is a better static stabiliser compared to MR. Studies dealing with MPFL repair alone also showed good clinical results, reinforcing the view that MPFL is the main stabiliser against lateral displacement of the patella [4,5,10,11,12,17,19], especially in lower angles of flexion.…”

Section: Introductionmentioning

confidence: 75%

“…As far as the MPFL is concerned, cadaveric studies showed a contribution of up to 50-60% to the stabil-ity of the patella [5,13]. Other stabilising structures are the medial patellomenisceal ligament (MPML) and the medial patellotibial ligament (MPTL) [13], plus the MR, which was the main subject of our study.…”

Section: Introductionmentioning

confidence: 83%

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Cadaveric-Biomechanical study on medial retinaculum: Its stabilising role for the patella against lateral dislocation

et al. 2015

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 75%

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Cadaveric-Biomechanical study on medial retinaculum: Its stabilising role for the patella against lateral dislocation

et al. 2015

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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 Instability

Sherman

Rund

Hinckel

et al. 2020

Lower Extremity Joint Preservation

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Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability

Abstract: III.

Cited by 44 publications

References 21 publications

Cadaveric-Biomechanical study on medial retinaculum: Its stabilising role for the patella against lateral dislocation

Cadaveric-Biomechanical study on medial retinaculum: Its stabilising role for the patella against lateral dislocation

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

Patellar Instability

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