LIVRE JDG 2012

S. Zaffagnini, P.G. Ntagiopoulos, D. Dejour, B. Sharma-Dort, S. Bignozzi, N. Lopomo, F. Colle

144

and 2-0 braided sutures (Vicryl) (fig. 3). The

superior 2/3

of the medial border of the patella

was exposed and freshened via sub-periosteal

dissection, without damaging the synovial

membrane. Two antero-posterior tunnels,

3.5mm wide each, were drilled short of the

patellar articular surface, 10mm below superior

patellar pole and 15mm lateral to medial

patellar pole, separated with 20mm bone in

between. These tunnels were connected in a

U-shaped tunnel, while a pulley was fashioned

in the medial retinaculum, 1cm medial to the

patella (fig. 4). After dissection of the MPFL,

the graft tunnel was positioned in the antero-

superior part of the native insertion, using a

7mm drill, over a k-wire, without violating the

lateral femoral cortex (fig. 5). The graft was

passed with suture passers, through the

U-shaped patellar tunnel, under the pulley and

into the blind femoral tunnel, when the knee

was cycled 10 times. The tension in the MPFL

was set to allow one quadrant lateral translation

of the medial facet with a firm end-point, with

out a medial tilt. The tension was maintained,

while the graft was fixed with interference

screws, in 70 degrees of knee flexion to ensure

central position in the trochlea.

Fig. 2: Experimental Setup showing frames for

navigation and axial quadriceps loading.

Fig. 3: Picture demonstrating a MPFL graft in

position, extending from a single blind femoral

tunnel on the right to a U-tunnel on medial patella

on the left.

Fig. 4: Schematic comparison of Native (black area)

and Graft MPFL Femoral Insertion (white area). The

graft was proximal and anterior to the MPFL

insertion.