Medial Patellofemoral Reconstruction With a Hamstring Allograft

Abstract

Background: Lateral patellar instability is common in young, active patients. Patients who fail conservative treatment may benefit from medial patellofemoral ligament (MPFL) reconstruction. Indications: Recurrent lateral patellar instability. Technique Description: Examination assesses patellar translation, eversion and range of instability. Diagnostic arthroscopy is performed for loose bodies, cartilage damage, trochlear dysplasia, and tracking. A longitudinal incision is made from superomedial to mid-body of the patella. The plane between the capsule and retinaculum is developed for palpation of the medial epicondyle and adductor tubercle. Electrocautery and rongeur are used to create a trough on the patella from centromedially to superomedially. Two suture anchors are placed at the proximal and distal trough. Fluoroscopy is utilized to identify Schöttle point with a perfect lateral radiograph. A 3-centimeter incision is made, and blunt dissection connects the 2 incisions in the developed plane. A guidepin is advanced at Schöttle point, and suture anchor sutures are shuttled through the plane, posterior to the guidepin. There should be loosening of tension with knee flexion. A semitendinosus allograft is whipstitched with terminal tapering. The whipstitched end is tunneled around the guidepin and brought back to the patella, so that both ends have an excess of 20 to 25 millimeters, and excess graft is trimmed from the free end prior to whipstitching. The doubled graft is sized. The midportion of the tendon is tagged and passed through both anchors. The graft is tensioned to the patellar trough and the graft ends are advanced through the developed plane. The femoral tunnel is reamed, and the graft is tensioned into the tunnel after nitinol wire placement with the knee in full extension. Isometry and lateral patellar translation are assessed, aiming for 1 quadrant with firm endpoint. The patella is proximalized and the tensioned graft is secured with an interference screw. Results: MPFL reconstruction is successful for the majority of patients, with 1.2% reporting instability, 3.6% apprehension, and 3.1% reoperation. Possible complications include patellar fracture, patellofemoral pain, and knee stiffness (loss of range of motion). Discussion/Conclusion: Lateral patellar instability is common, and MPFL reconstruction is typically successful for the majority of patients.