Anatomical two-bundle medial patellofemoral ligament reconstruction with hardware-free patellar graft fixation: technica
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Anatomical two-bundle medial patellofemoral ligament reconstruction with hardware-free patellar graft fixation: technical note and preliminary results Stefan Hinterwimmer • Andreas B. Imhoff • Philipp Minzlaff • Tim Saier • Nikolaus Rosenstiel Wolfried Hawe • Matthias J. Feucht
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Received: 8 January 2013 / Accepted: 3 April 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose Various techniques for reconstruction of the medial patellofemoral ligament (MPFL) have been developed. In this article, a modified technique for anatomical two-bundle MPFL reconstruction with hardware-free patellar graft fixation is described and the preliminary results of this technique are presented. Methods A modified surgical technique for MPFL reconstruction with a gracilis tendon autograft and hardware-free patellar graft fixation using two short oblique bone tunnels is described in detail. Complications and preliminary results of this procedure were assessed in 19 patients at a mean follow-up of 16 ± 3 months using the Kujala score, Tegner scale, and Insall score. Results No postoperative patellar dislocation or subluxation was reported. Eighty-nine per cent of the patients were either satisfied or very satisfied with the overall outcome. The mean Kujala score was 92 ± 7 (range 69–100), and the median Tegner scale was 5 (range 3–7). According to the Insall score, the results of 18 patients (95 %) were rated as good or excellent. Postoperative complications occurred in 3 patients (16 %), with two of them persisting only temporary. S. Hinterwimmer A. B. Imhoff (&) P. Minzlaff T. Saier N. Rosenstiel M. J. Feucht Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany e-mail: [email protected] S. Hinterwimmer Sportsclinic Germany, Ottobrunnerstr. 55, 81737 Munich, Germany W. Hawe Orthopa¨disches Fachzentrum, Deutenhausener Str. 4, 82362 Weilheim, Germany
Conclusions The described technique for anatomical twobundle MPFL reconstruction is a safe and effective surgical procedure for the treatment of lateral patellar instability, with several methodical advantages compared to similar techniques. Further evaluation in a larger patient cohort with a longer follow-up is necessary to confirm these shortterm results. Level of evidence IV. Keywords Medial patellofemoral ligament MPFL Patellar instability Hardware-free fixation
Introduction Numerous surgical procedures with variable results have been described to treat lateral patellar instability [8, 38]. Since biomechanical studies have highlighted the crucial role of the medial patellofemoral ligament (MPFL) in maintaining patellar stability [2, 12, 31], and radiographic studies as well as open surgical exploration have shown that rupture of the MPFL is the main pathoanatomical finding after lateral patellar dislocation [40, 49], reconstruction of the MPFL has become a widely accepted and successful treatment method for lateral patellar instability [3, 16]. Various techniques for MPFL reconstruction ha
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