J Richter1, P Mayer2, M Immendörfer2, M Schulz2, M Schlumberger2, P Schuster3. 1. Klinik für Sportorthopädie und arthroskopische Chirurgie, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland. j.richter@okm.de. 2. Klinik für Sportorthopädie und arthroskopische Chirurgie, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland. 3. Klinik für Sportorthopädie und arthroskopische Chirurgie, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Deutschland. philipp_schuster@gmx.de.
Abstract
OBJECTIVE: Anatomic reconstruction of the medial patellofemoral ligament using autologous gracilis tendon in an implant-free technique on the patellar side to regain patellofemoral stability. INDICATIONS: Recurrent dislocations, primary dislocation with high risk of recurrence, and dislocations with (osteo-)chondral flake fractures. As combined approach together with other procedures (trochleoplasty, tibial tubercle osteotomy). Revisions. CONTRAINDICATIONS: As an isolated procedure in patients with high degrees of trochlear dysplasia, chronic dislocation of the patella, and patellofemoral maltracking without instability. SURGICAL TECHNIQUE: Harvesting of the gracilis tendon. Drilling of a V-shaped tunnel with a special aiming device in anatomic position on the medial side of the patella. Drilling of a femoral tunnel in anatomic position under fluoroscopic control. Passage of the graft, arthroscopic-guided tensioning, and femoral fixation with a biodegradable interference screw. POSTOPERATIVE MANAGEMENT: Partial weight bearing (20 kg) for 1-2 weeks. No limitation in range of motion. No orthosis. Specific sports allowed after approximately 3 months. RESULTS: Perioperative complications associated specifically with the technique were observed in 1.0% (7 of 729 cases). In a series of 72 consecutive cases from May 2010 to October 2010, the following were recorded after 4.0 ± 0.1 years: recurrent dislocations in 3.2%, a Tegner activity score of 5.1 ± 1.8, and subjective satisfaction in 92% (follow-up rate 87.5%). No fracture of the patella was seen in any of our patients.
OBJECTIVE: Anatomic reconstruction of the medial patellofemoral ligament using autologous gracilis tendon in an implant-free technique on the patellar side to regain patellofemoral stability. INDICATIONS: Recurrent dislocations, primary dislocation with high risk of recurrence, and dislocations with (osteo-)chondral flake fractures. As combined approach together with other procedures (trochleoplasty, tibial tubercle osteotomy). Revisions. CONTRAINDICATIONS: As an isolated procedure in patients with high degrees of trochlear dysplasia, chronic dislocation of the patella, and patellofemoral maltracking without instability. SURGICAL TECHNIQUE: Harvesting of the gracilis tendon. Drilling of a V-shaped tunnel with a special aiming device in anatomic position on the medial side of the patella. Drilling of a femoral tunnel in anatomic position under fluoroscopic control. Passage of the graft, arthroscopic-guided tensioning, and femoral fixation with a biodegradable interference screw. POSTOPERATIVE MANAGEMENT: Partial weight bearing (20 kg) for 1-2 weeks. No limitation in range of motion. No orthosis. Specific sports allowed after approximately 3 months. RESULTS: Perioperative complications associated specifically with the technique were observed in 1.0% (7 of 729 cases). In a series of 72 consecutive cases from May 2010 to October 2010, the following were recorded after 4.0 ± 0.1 years: recurrent dislocations in 3.2%, a Tegner activity score of 5.1 ± 1.8, and subjective satisfaction in 92% (follow-up rate 87.5%). No fracture of the patella was seen in any of our patients.
Authors: Hui Jun Kang; Fei Wang; Bai Cheng Chen; Yan Ling Su; Zhan Chi Zhang; Chang Bao Yan Journal: Knee Surg Sports Traumatol Arthrosc Date: 2010-03-16 Impact factor: 4.342