Double-Bundle Quadriceps Tendon Autograft for Reconstruction of the Medial Patellofemoral Complex to Manage Recurrent Patellar Dislocation in Patients With Open Physes

Overview

Journal Arthrosc Tech

Publisher Elsevier

Date 2023 May 4

PMID 37138680

Authors

Assem Mohamed Noureldin Zein

Alaa Zenhom Mahmoud Hassan

Affiliations

Soon will be listed here.

Abstract

Management of chronic patellar instability in patients with open physis requires special reconstruction techniques to minimize the risks of femoral growth plate injury due to the close proximity of the open physis to the native femoral origin of the medial patellofemoral ligament (MPFL). Children and adolescents have a relatively smaller patella than the adult group, so, there is a higher risk of patellar fracture when tunnels are performed in the patella. It is wise to mimic the normal anatomy of the medial patellofemoral complex (MPFC) by reconstruction of both of the medial quadriceps tendon femoral ligament (MQTFL) and MPFL, so as to restore the normal fan-shaped MPFC, with its wide anterior attachment to both of the patella and quadriceps tendon (QT). This article describes a simple, safe, reproducible, and cost effective technique for surgical management of chronic patellar instability in patients with open physis by reconstruction of the MPFC using a double-bundle QT autograft.

Citing Articles

Outcomes of an All-Soft Tissue Fixation Technique for Reconstruction of the Medial Patellofemoral Complex Using Double-Bundle Quadriceps Tendon Autograft for Recurrent Patellar Dislocation in Skeletally Immature Patients.

Zein A, Allam A, Hassan A, Soliman A, Mohamed M Orthop J Sports Med. 2024; 12(6):23259671241259051.

PMID: 38895137 PMC: 11185005. DOI: 10.1177/23259671241259051.

Outcomes of surgical treatment of patellar instability in children with Down syndrome.

Zein A, Hassan A, Soliman A, Mohamed M J Orthop Surg Res. 2024; 19(1):263.

PMID: 38664709 PMC: 11044411. DOI: 10.1186/s13018-024-04730-y.

References

Fithian D, Paxton E, Stone M, Silva P, Davis D, Elias D . Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004; 32(5):1114-21. DOI: 10.1177/0363546503260788. View

Imhoff F, Funke V, Muench L, Sauter A, Englmaier M, Woertler K . The complexity of bony malalignment in patellofemoral disorders: femoral and tibial torsion, trochlear dysplasia, TT-TG distance, and frontal mechanical axis correlate with each other. Knee Surg Sports Traumatol Arthrosc. 2019; 28(3):897-904. DOI: 10.1007/s00167-019-05542-y. View

Kepler C, Bogner E, Hammoud S, Malcolmson G, Potter H, Green D . Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med. 2011; 39(7):1444-9. DOI: 10.1177/0363546510397174. View

Kruckeberg B, Chahla J, Moatshe G, Cinque M, Muckenhirn K, Godin J . Quantitative and Qualitative Analysis of the Medial Patellar Ligaments: An Anatomic and Radiographic Study. Am J Sports Med. 2017; 46(1):153-162. DOI: 10.1177/0363546517729818. View

Seeley M, Bowman K, Walsh C, Sabb B, Vanderhave K . Magnetic resonance imaging of acute patellar dislocation in children: patterns of injury and risk factors for recurrence. J Pediatr Orthop. 2012; 32(2):145-55. DOI: 10.1097/BPO.0b013e3182471ac2. View

Amis A, Firer P, Mountney J, Senavongse W, Thomas N . Anatomy and biomechanics of the medial patellofemoral ligament. Knee. 2003; 10(3):215-20. DOI: 10.1016/s0968-0160(03)00006-1. View

Ziegler C, Fulkerson J, Edgar C . Radiographic Reference Points Are Inaccurate With and Without a True Lateral Radiograph: The Importance of Anatomy in Medial Patellofemoral Ligament Reconstruction. Am J Sports Med. 2015; 44(1):133-42. DOI: 10.1177/0363546515611652. View

Kang H, Wang F, Chen B, Su Y, Zhang Z, Yan C . Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2010; 18(11):1511-6. DOI: 10.1007/s00167-010-1090-8. View

Howells N, Eldridge J . Medial patellofemoral ligament reconstruction for patellar instability in patients with hypermobility: a case control study. J Bone Joint Surg Br. 2012; 94(12):1655-9. DOI: 10.1302/0301-620X.94B12.29562. View

10.

Wang Q, Huang W, Cai D, Huang H . Biomechanical comparison of single- and double-bundle medial patellofemoral ligament reconstruction. J Orthop Surg Res. 2017; 12(1):29. PMC: 5304392. DOI: 10.1186/s13018-017-0530-2. View

11.

Neri T, Philippot R, Carnesecchi O, Boyer B, Farizon F . Medial patellofemoral ligament reconstruction: clinical and radiographic results in a series of 90 cases. Orthop Traumatol Surg Res. 2014; 101(1):65-9. DOI: 10.1016/j.otsr.2014.09.023. View

12.

Shea K, Styhl A, Jacobs Jr J, Ganley T, Milewski M, Cannamela P . The Relationship of the Femoral Physis and the Medial Patellofemoral Ligament in Children: A Cadaveric Study. Am J Sports Med. 2016; 44(11):2833-2837. DOI: 10.1177/0363546516656366. View

13.

Rood A, Hannink G, Lenting A, Groenen K, Koeter S, Verdonschot N . Patellofemoral Pressure Changes After Static and Dynamic Medial Patellofemoral Ligament Reconstructions. Am J Sports Med. 2015; 43(10):2538-44. DOI: 10.1177/0363546515594447. View

14.

Sanchis-Alfonso V, Ginovart G, Alastruey-Lopez D, Montesinos-Berry E, Monllau J, Alberich-Bayarri A . Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model. J Clin Med. 2019; 8(12). PMC: 6947356. DOI: 10.3390/jcm8122093. View

15.

Zhang Z, Zhang H, Song G, Zheng T, Ni Q, Feng H . Increased femoral anteversion is associated with inferior clinical outcomes after MPFL reconstruction and combined tibial tubercle osteotomy for the treatment of recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc. 2019; 28(7):2261-2269. DOI: 10.1007/s00167-019-05818-3. View

16.

Negrin R, Reyes N, Iniguez M, Gaggero N, Sandoval R, Jabes N . Dynamic-Anatomical Reconstruction of Medial Patellofemoral Ligament in Open Physis. Arthrosc Tech. 2020; 9(7):e1027-e1032. PMC: 7372519. DOI: 10.1016/j.eats.2020.03.018. View

17.

Conlan T, Garth Jr W, Lemons J . Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am. 1993; 75(5):682-93. DOI: 10.2106/00004623-199305000-00007. View

18.

Fulkerson J, Edgar C . Medial quadriceps tendon-femoral ligament: surgical anatomy and reconstruction technique to prevent patella instability. Arthrosc Tech. 2013; 2(2):e125-8. PMC: 3716224. DOI: 10.1016/j.eats.2013.01.002. View

19.

Hautamaa P, Fithian D, Kaufman K, Daniel D, Pohlmeyer A . Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res. 1998; (349):174-82. DOI: 10.1097/00003086-199804000-00021. View

20.

Placella G, Tei M, Sebastiani E, Criscenti G, Speziali A, Mazzola C . Shape and size of the medial patellofemoral ligament for the best surgical reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2014; 22(10):2327-33. DOI: 10.1007/s00167-014-3207-y. View