A novel Medial Patellofemoral Ligament Reconstruction Technique; Preliminary Clinical Results

Abstract

Medial Patellofemoral ligament(MPFL) is the main passive stabilizer of the patellofemoral joint. MPFL is injured in the 2/3 rds of the patients after patella luxation. In this study we present a novel aproach to the anatomical MPFL reconstruction and preliminary results of the technique. We operated 7 patients(4 female and female and 3 male) who applied to our clinic after a patella luxation episode. The mean age was 27,1 years(16-42). The mean follow up time was 23,5 months(24-35). We evaluated the patients clinically and radiologically for concommitant pathologies. 1 patient had patellar cartilage demage and patella alta, 1 patient had medial collateral ligament rupture, 1 patient had lateral collateral ligament and anterior cruciate ligament rupture and these pathologies were treated as well. The operation was done in the supine position on a radiolucent table and under the image intensifier control. The semitendinosus autograft was prepared. The femoral tunnel was drilled and double strand graft was introduced in the femoral tunnel and secured with ToggleLoc femoral fixation device(Biomet). The graft was advanced over the facia to the patellar side and passed through the 2 patellar tunnels and tied to each other. After exercising the knee the graft tension was rechecked at 30 degrees of knee flexion. Early postoperatively range of motion and quadriceps strenghtening exercises were carried out and patients were allowed to bear weight. All of the patients had full range of motion and free of pain. Postoperative x-ray and MRI examinations revealed the correction of patellar tilt and lateral shift of the patella in all patients. The only complication was a fissure of patella in 1 patient in the 6th week of rehabilitation due to anteriorly located patellar tunnel and heavy exercise. We immobilsed the patient in a brace and the patient returned to rehabilitation after 6 weeks when the fissure healed. All the patients returned to the previous functional level. Our anatomical MPFL technique uses ToggleLoc for the femoral side but implant free at the patellar side. The technique provided excellent preliminiary result in all of the patients. The technique allows graft retensioning again and again from both the femoral and the patellar side. The double bundle reconstruction seems to immitate the natural behaviour of the MPFL. However patellar tunnels carry a substantial risk of patella fracture and must be placed with great attention.