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Introduction
Medial patellofemoral ligament (MPFL) is an
established primary static stabilizer of lateral
patellar dislocation and its lesion labeled as
essential for acute and chronic cases of patellar
dislocation (fig. 1) [1-4]. Over the last decade,
its anatomic reconstruction in clinical patellar
instability has been studied. Combination of
MPFL reconstruction with other procedures
like tibial tubercle osteotomies and
trochleoplasties has also generated interest [5-
9]. There is no clear consensus on a single
surgical technique, graft options, fixation
methods and angle of flexion at fixation [5, 6,
10, 11]. A single, blind femoral tunnel, between
the adductor tubercle and medial epicondyle,
with two patellar tunnels using one hamstring
tendon is currently accepted widely [12-15].
In this background, it is suitable to study MPFL
reconstruction technique using the navigation
system to record patellar kinematics on a
cadaveric model.
Materials and methods
The study was carried out on six normal
cadaveric knee specimens, aged between 41-60
years, two males and four females. After hip
disarticulation and subcutaneous dissection
20cm proximally, each femur was clamped and
quadriceps tendon was loaded with 60N axial
load (fig. 2). The tibia was moved manually
through 0-90 degrees of flexion with native and
then, reconstructed MPFL to record the patellar
kinematics via an imageless navigation system
(BLUIGS, Orthokey LLC, Lewes, Delaware).
The femoral insertion of the native and graft
MPFLwas acquired after resection of the native
MPFL, along with the medial epicondyle.
Surgical technique for MPFL
reconstruction
A 22-25cm length of gracillis graft was
prepared using a standard harvesting technique
MPFL Reconstruction:
Navigation and Angle
of Fixation
S. Zaffagnini, P.G. Ntagiopoulos,
D. Dejour, B. Sharma, S. Bignozzi,
N. Lopomo, Ing. F. Colle, M. Marcacci
Fig. 1: Cadaveric Knee showing the isolated, native
Medial Patello-femoral Ligament.