LIVRE JDG 2012

Minimal invasive reconstruction of the MPFL using Quadriceps tendon

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The graft is left attached distally and the free

proximal end is armed with resorbable sutures

in web stitch technique.

Distally the longitudinal cuts are continued

with a surgical knife towards the patella and

over the patellar surface in the chosen width

(10 or 12mm) (Lateral: 2cm, medial: 1cm on

the surface of the patella). The quadriceps

tendon strip is than subperiostally elevated

from the surface of the patella.

The proximal 1.5cmof the medial patellar border

is then exposed. From the medial patella border

the prepatellar tissue is elevated towards laterally

creating a tunnel reaching the medial edge of the

graft. This is performed best with a periostial

elevator (fig. 7) ), so that anterior cortex of the

patella in the tunnel is gently abraded. A surgical

clamp is introduced into the tunnel from medial

to lateral and the graft is passed through the

tunnel (fig. 8). The graft pulled through the

tunnel should lie flat on the abraded cortex of the

patellar surface, so that fast and broad graft-to-

bone healing can be expected. The graft is then

secured to the retinaculum tissue on the medial

patellar edge by resorbable sutures (fig. 9).

A 1.5cm skin incision is then made over the

adductor tubercle. Starting at the patella a

curved clamp is used to create a tunnel in the

space between the vastus medialis and the

capsule. A suture loop is then pulled through

the tunnel. This loop is used later to pull the

graft towards the femoral insertion.

Under fluoroscopic guidance a 2.4mm guide

pin is drilled into the insertion of the MPFL [8].

It is directed antero-laterally to exit the femur

Fig. 7

Fig. 8

Fig. 9

Fig. 10