Suture Tape Augmentation Repair of the Medial Patellofemoral Ligament

Abstract

Adolescents with osteochondral loose bodies after a first-time patellar dislocation are most commonly treated with surgical intervention. However, the ideal method of managing a concurrent medial patellofemoral ligament (MPFL) disruption is still unknown. Recent evidence suggests high failure rates are associated with primary MPFL repair. The purpose of this Technical Note is to describe an alternative surgical technique for managing acute first-time patellar dislocations by using high-strength suture augmentation of the MPFL.

Arthroscopically Assisted Double-Bundle Medial Patellofemoral Ligament Augmentation With Physeal-Sparing Suture Fixation for Recurrent Patellar Dislocation in Skeletally Immature Patients

“…MPFL augmentation has been investigated in many studies but mainly among skeletally mature patients. 17 , 18 , 22 , 23 The success rate of MPFL augmentation for preventing recurrent dislocations exceeded 90% at both short-term and long-term follow-up in adults. 22 Lee et al.…”

“…Sherman et al. 18 first described open MPFL augmentation in children and adolescents in a technical report. Different from the suture anchor technique used by Sherman et al., 18 the described procedure applies a double-tunnel transosseous suture fixation technique at the femoral origin of the MPFL.…”

“… 18 first described open MPFL augmentation in children and adolescents in a technical report. Different from the suture anchor technique used by Sherman et al., 18 the described procedure applies a double-tunnel transosseous suture fixation technique at the femoral origin of the MPFL. No interference screw is used, and the modified femoral tunnels created by cutting needle are small in size, which helps to preserve the integrity of the native femoral attachment to the greatest extent.…”

“…Augmentation refers to a technique that reproduces the structure of soft-tissue stabilizers by using suture tape or bioactive material as an “artificial ligament.” 16 , 17 , 18 The tape is supposed to act as a secondary stabilizer and to protect the native ligament during its biological healing by preventing increased patellar lateralization. 16 , 18 A recent biomechanical study confirmed similar contact pressures and joint kinematics between MPFL augmentation and MPFL-R using tendon grafts in almost all degrees of knee flexion. 16 To avoid injury of the epiphyseal plate, osseous femoral fixation during MPFL augmentation for adults should not be mechanically transplanted to young patients.…”

Medial Patellofemoral Ligament Augmentation Repair for Primary Patellar Dislocation With Concomitant Chondral or Osteochondral Injury in Children and Adolescents: Outcomes at Minimum 2-Year Follow-up

“…The suture tape was affixed to the anatomic femoral insertion with an absorbable 4.75-mm suture anchor (SwiveLock) under fluoroscopic guidance using the technique described by Schöttle et al 28 The patella was held with its lateral border aligned to the lateral aspect of the femoral trochlea, and a curved hemostat was placed under the tape before final fixation to prevent overtightening of the suture. 31 The knee was taken through a range of motion (ROM) to confirm appropriate patellar tracking before sutures were tied and cut ( Figure 1 ).…”