Simultaneous Medial and Lateral Patellofemoral Ligament Reconstruction for Combined Medial and Lateral Patellar Subluxation

Saper, Michael G.; Shneider, David A.

doi:10.1016/j.eats.2013.10.004

Cited by 6 publications

(2 citation statements)

References 16 publications

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“…Saper and Shneider reported on 46 knees using a single continuous hamstring allograft spanning from the MPFL origin through the distal aspect of the quadriceps tendon to the LPFL origin. 26 They found 95.6% of patients were stable without subluxation at 1 year with no complications, although they reported no other outcome measures. While the stability results are encouraging, there are a number of weaknesses to this technique.…”

Section: Discussionmentioning

confidence: 95%

Medial Patellofemoral Ligament Reconstruction With Concomitant Lateral Patellofemoral Reconstruction for Patellar Instability

Parvaresh¹,

Huddleston²,

Yanke³

2021

Arthroscopy Techniques

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Patients with bidirectional patellar instability who are unresponsive to conservative management may benefit from a medial patellofemoral ligament (MPFL) reconstruction and lateral patellofemoral ligament (LPFL) reconstruction. If an isolated MPFL reconstruction does not provide adequate stabilization intraoperatively, combined MPFL and LPFL reconstruction allows independent reconstruction, which can be performed with a facile, reproducible technique. The purpose of this report was to describe our technique for performing an MPFL reconstruction with a concurrent soft-tissue LPFL reconstruction combined with a distalizing tibial tubercle osteotomy to correct patella alta.

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Section: Discussionmentioning

confidence: 95%

Medial Patellofemoral Ligament Reconstruction With Concomitant Lateral Patellofemoral Reconstruction for Patellar Instability

Parvaresh¹,

Huddleston²,

Yanke³

2021

Arthroscopy Techniques

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“…24 In contrast, others may prefer to fixate the graft when it is reduced in the trochlea (at 30° of flexion) 25,26 or at even higher degrees of flexion, up to 60°. 27 Future studies are needed to further investigate the role of these different technical aspects on the biomechanics and clinical outcomes of LFPL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Lateral Patellofemoral Ligament Reconstruction: A Biomechanical Comparison of 2 Techniques

et al. 2023

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Background: The importance of maintaining lateral patellar stabilizing structures has been demonstrated by the presence of iatrogenic medial patellar instability after lateral retinacular release (LRR) procedures. In patients with medial patellar instability, lateral patellofemoral ligament (LPFL) reconstruction has been clinically shown to restore patellar stability while improving patient-reported outcomes. However, the biomechanics associated with different LPFL reconstruction techniques remain largely unknown. Purpose: To (1) investigate whether LPFL reconstruction restores medial patellar translation compared with the intact state after LRR and (2) evaluate for any biomechanical differences between soft tissue and osseous LPFL reconstruction techniques. Study Design: Controlled laboratory study. Methods: A total of 7 knees were included in the final analysis. The knees were dissected, and the tibia and femur were potted. An eye screw was then placed at the midpoint of the patella perpendicular to the medial surface. A custom jig was constructed to allow for a 1-kg load to be applied to the quadriceps muscle. Medial patellar displacement was investigated at 0°, 10°, 20°, 30°, 45°, 60°, and 90° of knee flexion using a tensile testing machine with a 20-N medial force applied to the patella. Medial patellar displacement was assessed in 4 states: intact, LRR, soft tissue LPFL reconstruction (inserted through incisions in the iliotibial band, quadriceps tendon, and patellar tendon), and osseous LPFL reconstruction. Results: The LRR group had significantly greater medial patellar translation compared with the intact group throughout flexion ( P < .01 to P = .029). The soft tissue LPFL reconstruction group demonstrated significantly greater medial patellar translation at 30° ( P = .020) and 45° ( P = .025) compared with the intact group, with less translation compared with the LRR group at all degrees of knee flexion except for 45° ( P = .065). The osseous LPFL reconstruction group demonstrated significantly greater medial patellar translation compared with the intact group at 30° of flexion ( P = .036), with significantly less translation compared with the LRR group from 0° to 30° ( P < .01 to P = .013). The soft tissue LPFL reconstruction group (15.94 ± 2.55 mm) demonstrated significantly greater medial patellar translation at 10° of flexion compared with the osseous LPFL reconstruction group (14.16 ± 2.34 mm) ( P = .033). Conclusion: Soft tissue LPFL reconstruction led to significantly greater medial patellar translation at 30° and 45° compared with the intact state, while osseous LPFL reconstruction produced significantly greater translation only at 30°. Both the soft tissue and the osseous reconstruction techniques resulted in comparable medial patellar translation at all degrees of knee flexion except for 10°, in which osseous reconstruction was more similar to the intact state. Clinical Relevance: Compared with LRR, soft tissue LPFL reconstruction was able to restore stability against medial patellar translation at most degrees of knee flexion, while osseous LPFL reconstruction did not provide adequate stabilization beyond 30° of flexion. While the LPFL does appear to have osseous insertions, soft tissue reconstruction functioned more similarly to the intact state after LRR.

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Clinical results after treatment for bidirectional patellar subluxation: Minimum 2-years follow-up

et al. 2016

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Simultaneous Medial and Lateral Patellofemoral Ligament Reconstruction for Combined Medial and Lateral Patellar Subluxation

Cited by 6 publications

References 16 publications

Medial Patellofemoral Ligament Reconstruction With Concomitant Lateral Patellofemoral Reconstruction for Patellar Instability

Medial Patellofemoral Ligament Reconstruction With Concomitant Lateral Patellofemoral Reconstruction for Patellar Instability

Lateral Patellofemoral Ligament Reconstruction: A Biomechanical Comparison of 2 Techniques

Clinical results after treatment for bidirectional patellar subluxation: Minimum 2-years follow-up

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