[Anatomical double-bundle reconstruction of the medial patellofemoral ligament with a gracilis autograft].

OBJECTIVE: Elimination of patellofemoral instability by reconstruction of the medial patellofemoral ligament (MPFL) with a gracilis autograft. INDICATIONS: Recurring lateral luxation and subluxation of the patella, tibial tuberosity-trochlear groove distance (TTTG) < 20 mm, persistent positive apprehension test in up to 45° of flexion, low grade trochlear dysplasia. CONTRAINDICATIONS: Traumatic luxation of the patella without anatomical risk factors, isolated treatment if TTTG  > 20 mm, and isolated treatment for high-grade trochlear dysplasia (type B, C, D). SURGICAL TECHNIQUE: Supine postion. Stripping of the gracilis tendon. Drilling of two tunnels into the medial margin of the patella. Insertion of both tendon ends into the tunnels and fixation with resorbable screwlocks. Undermining of the fascia of the medial oblique vastus muscle and insertion of the tendon loop into the femoral point of insertion located at the medial epicondyle. Preparation of the femoral point of insertion and drilling of the femoral tunnel. Insertion of the graft into the femoral tunnel. Positioning of the knee in 30° of flexion. Positioning of the patella and fixation of the graft with a resorbable screw. POSTOPERATIVE MANAGEMENT: Two weeks of partial weight bearing. Knee orthesis for 6 weeks. Passive motion up to 60° of flexion for the first 2 weeks. Three weeks postoperatively unrestricted motion exercises, strengthening of the quadriceps muscle. Unlimited activity is possible 3 months postoperatively.
RESULTS: The method presented in this manuscript was performed on 32 patients with recurring patellar luxation; 27 patients were available for clinical assessment at 1 year postoperatively. There were no recorded events of reluxation; the Kujala score increased on average from 61 points preoperatively to 93 points postoperatively.