Reconstruction of the Medial Patellofemoral Ligament Using the Adductor Magnus Tendon

Sillanpää, Petri; Arendt, Elizabeth A.

doi:10.1016/j.arthro.2012.08.010

Cited by 4 publications

(10 citation statements)

References 5 publications

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“…Donor-site tenderness and muscle retraction were outlined by previous authors as potential complications of this technique, but only in cases when there was a need to harvest the full volume of the tendon. 28,32,50,51 Similar complications have been reported in reconstruction techniques of other ligaments with the use of various tendinous graft sources (ie, quadriceps, semitendinosus, gracilis tendons). However, we strongly believe that the remaining volume, intact aponeurotic attachment, and medial intermuscular septum integrated with the fibers of the membranous segment of the tendon provide sufficient pull on the AT and minimize the possibility of postoperative muscle retraction.…”

Section: Discussionmentioning

confidence: 57%

“…The flat AT graft matches the morphology of the native MPFL to a much higher degree than the tubular ribbonshaped structure of the traditionally and most frequently utilized semitendinosus and gracilis tendon grafts. 3,28,50 A relatively large diameter of the AT allowed for only partial splitting of the tendon in all of the tested specimens, without the need for a complete disruption of its anatomic integrity. When the graft was harvested, the physiological attachment and a considerable volume of the native tendon were left intact.…”

Section: Discussionmentioning

confidence: 99%

“…This presents a very significant revelation of the current study, since injury to the surrounding neurovascular structures has been outlined as one of the primary risks and concerns of this technique. 28,50,52 To achieve the desired length of the graft at 7.5 6 0.5 cm, the harvested portion of the tendon always exceeded the length of the native MPFL by 25 to 30 mm. This additional length of the graft potentially allows for application of the tendon flap at the patellar fixation site, as well as several other modifications of the soft or bony fixations depending on the surgeon's preference (transosseous patellar fixation, suture anchors, etc).…”

Section: Discussionmentioning

confidence: 99%

“…One technique that uses the adductor magnus muscle tendon to gain a flat, broad graft leaving its distal femoral insertion intact was initially introduced by Avikainen et al 10 in 1993. Since then, the adductor tenodesis technique was modified and presented in several studies from Sillanpä ä et al [49][50][51][52] In contrast to most other techniques, this graft's application does not require drilling at or near the femoral physis, and it additionally allows for soft tissue patellar fixation, making it a beneficial graft option for the skeletally immature patient population. Since the insertion of the adductor tendon (AT) is in proximity to that of the native MPFL, the proposed technique allows for anatomic reconstruction, which is considered the most appropriate means of operative treatment.…”

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confidence: 99%

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Anatomic and Biomechanical Properties of Flat Medial Patellofemoral Ligament Reconstruction Using an Adductor Magnus Tendon Graft: A Human Cadaveric Study

Milinkovic

Fink

Kittl³

et al. 2021

Am J Sports Med

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Background: In contrast to the majority of existing techniques for reconstruction of the medial patellofemoral ligament (MPFL), the technique described in this article uses the adductor magnus muscle tendon to gain a flat, broad graft, leaving its distal femoral insertion intact, and does not require drilling within or near the femoral physis. It also allows for soft tissue patellar fixation and could facilitate anatomic MPFL reconstruction in skeletally immature patients. Purpose: To evaluate the anatomic and structural properties of the native MPFL and the adductor tendon (AT), followed by biomechanical evaluation of the proposed reconstruction. Study Design: Descriptive laboratory study. Methods: The morphological and topographical features of the AT and MPFL were evaluated in 12 fresh-frozen cadaveric knees. The distance between the distal insertion of the AT on the adductor tubercle and the adductor hiatus, as well as the desired length of the graft, was measured to evaluate this graft’s application potential. Load-to-failure tests were performed to determine the biomechanical properties of the proposed reconstruction construct. The construct was placed in a uniaxial testing machine and cyclically loaded 500 times between 5 and 50 N, followed by load to failure, to measure the maximum elongation, stiffness, and maximum load. Results: The mean ± SD length of the AT was 12.6 ± 1.5 cm, and the mean distance between the insertion on the adductor tubercle and adductor hiatus was 10.8 ± 1.3 cm, exceeding the mean desired length of the graft (7.5 ± 0.5 cm) by 3.3 ± 0.7 cm. The distal insertion of the AT was slightly proximal and posterior to the insertion of the MPFL. The maximum elongation after cyclical loading was 1.9 ± 0.4 mm. Ultimately, the mean stiffness and load to failure were 26.2 ± 7.6 N/mm and 169.7 ± 19.2 N, respectively. The AT graft failed at patellar fixation in 2 of the initially tested specimens and at the femoral insertion in the remaining 10. Conclusion: The described reconstruction using the AT has potential for MPFL reconstruction. The AT graft presents a graft of significant volume, beneficial anatomic topography, and adequate tensile properties in comparison with the native MPFL following the data from previously published studies. Clinical Relevance: Given its advantageous anatomic relationship as an application that avoids femoral drilling and osseous patellar fixation, the AT may be considered a graft for MPFL reconstruction in skeletally immature patients.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Anatomic and Biomechanical Properties of Flat Medial Patellofemoral Ligament Reconstruction Using an Adductor Magnus Tendon Graft: A Human Cadaveric Study

Milinkovic

Fink

Kittl³

et al. 2021

Am J Sports Med

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“…The femoral attachment site can be 10 mm proximal and 2 mm posterior from the medial femoral epicondyle, or 4 mm distal and 2 mm anterior from the adductor tubercle (11). Fluoroscopic imaging of a lateral view of the knee can be used to identify the femoral insertion point (19,20).…”

Section: Case Reportmentioning

confidence: 99%

Treatment of patellar instability in a case of hereditary onycho-osteodysplasia (nail-patella syndrome) with medial patellofemoral ligament reconstruction: A case report

Yang

Liu

et al. 2016

Experimental and Therapeutic Medicine

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Abstract.Hereditary onycho-osteodysplasia, also known as nail-patella syndrome (NPS), is a rare genetic disorder that is primarily characterized by poorly developed nails and patella. Patients with NPS frequently suffer from patellar instability that requires surgical management. The present case report describes a 25-year-old man with NPS. The patient presented with left knee pain and was found to have recurrent left patellar dislocation. The knee pain was first reported 1-year after a minor knee trauma incident. Following complete evaluation, a diagnosis of NPS was reached. The patient underwent surgical intervention using medial patellofemoral ligament (MPFL) reconstruction with a gracilis tendon autograft looped through two transverse 3.2-mm drill holes in the patella and fixed at the natural MPFL insertion site on the medial femoral condyle with an interference screw. The surgery resulted in stabilization of the patella in the femoral trochlea and the patient did not have any subsequent dislocations or subluxations. The patient had an excellent range of knee movement in the follow-up period. This case indicates that MPFL reconstruction in patients with patellar dislocation secondary to NPS can successfully restore normal patellar tracking and result in good range of movement and functional activity.

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Return to sport after patellar dislocation or following surgery for patellofemoral instability

Ménétrey

Putman

Gard

2014

Knee Surg Sports Traumatol Arthrosc

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Patellofemoral instability may occur in a young population as a result of injury during sporting activities. This review focuses on return to sport after one episode of dislocation treated no operatively and as well after surgery for chronic patellofemoral instability. With or without surgery, only two-thirds of patients return to sports at the same level as prior to injury. A high-quality rehabilitation programme using specific exercises is the key for a safe return to sporting activities. To achieve this goal, recovery of muscle strength and dynamic stability of the lower limbs is crucial. The focus should be directed to strengthen the quadriceps muscle and pelvic stabilizers, as well as lateral trunk muscle training. Patient education and regularly performed home exercises are other key factors that can lead to a successful return to sports. The criteria for a safe return to sports include the absence of pain, no effusion, a complete range of motion, almost symmetrical strength, and excellent dynamic stability.Level of evidence IV.

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Reconstruction of the Medial Patellofemoral Ligament Using the Adductor Magnus Tendon

Cited by 4 publications

References 5 publications

Anatomic and Biomechanical Properties of Flat Medial Patellofemoral Ligament Reconstruction Using an Adductor Magnus Tendon Graft: A Human Cadaveric Study

Anatomic and Biomechanical Properties of Flat Medial Patellofemoral Ligament Reconstruction Using an Adductor Magnus Tendon Graft: A Human Cadaveric Study

Treatment of patellar instability in a case of hereditary onycho-osteodysplasia (nail-patella syndrome) with medial patellofemoral ligament reconstruction: A case report

Return to sport after patellar dislocation or following surgery for patellofemoral instability

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