Proximal Medial Patella Restraint Reconstruction: Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament Reconstruction.

BACKGROUND

The proximal medial patella restraints (PMPR) are comprised of the medial patellofemoral ligament (MPFL) and the medial quadriceps tendon femoral ligament (MQTFL) and serve as the principal patellar stabilizers in early to mid-flexion of the knee.

INDICATIONS: PMPR reconstruction is an ideal stabilization technique for recurrent patellar instability or after a first-time dislocation associated with an osteochondral fracture requiring surgical treatment.

TECHNIQUE DESCRIPTION: A single 3 to 4 cm longitudinal incision is made at the midpoint between the medial patella and medial epicondyle. A single hamstring allograft is used. This graft is passed through a slit in the medial aspect of the quadriceps tendon deep to the vastus medialis toward the origin on the femur to create the MQTFL limb. The remaining MPFL limb is anchored to its inferior insertion site on the patella, then laid into a trough along the medial patella. The 2 limbs are then passed through a femoral socket and anchored with a PEEK tenodesis screw at 45° of flexion.

RESULTS

The patient's patellar stability was markedly improved with normal physiologic translation, and she was able to return to competitive softball without further dislocation events. Studies evaluating similar combined MPFL/MQTFL reconstructions have reported improvements in recurrent instability.

DISCUSSION/

CONCLUSION

This technique for PMPR reconstruction may provide more anatomic and physiologic medial patellar stabilization in cases of patellar instability without increasing time, cost, or complexity of the procedure or recovery.

PATIENT CONSENT DISCLOSURE STATEMENT: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.