Reconstruction of the medial patellofemoral ligament (MPFL) has been described utilizing a myriad of fixation techniques. We have elected to utilize a technique that secures the graft to the femur with an interference screw and secures the graft to the patella by suturing it to itself after threading it through bone tunnels. This allows for easy tensioning of the graft while not sacrificing fixation.
The medial patellofemoral ligament (MPFL) has been recognized as the primary stabilizer against lateral patellar dislocation or subluxation.2,4,5 Consequently if there is lateral patellar instability there is also an insufficient MPFL.
Similar to other ligamentous reconstructions around the knee, medial patellofemoral ligament (MPFL) reconstructions can lead to complications. These complications relate to a lack of understanding of the biomechanics of the MPFL ligament and technical errors made during the reconstruction.
Ostensibly, reconstruction of the lateral patellofemoral ligament should be used for the treatment of medial instability of the patella.1,6,7,15 And that it should. But in my hands, a far more frequent use of this lateral reconstruction is for the surgical reconstruction of the extensor mechanism of knee after having failed prior surgery for the treatment of lateral instability of the patella when...
Medial dislocation or subluxation of the patella is a disabling condition that can occur after an isolated lateral release, or after lateral release in combination with tibial tubercle transfer or medial soft tissue imbrications.
A normal patellofemoral gliding mechanism with perfect stability is guaranteed by the complex interaction of skeletal geometry, soft tissues, and neuromuscular control.10 During knee flexion, the patella moves from a medial to a lateral tilted positionas knee flexion approaches 90°.29,32,33,51,53Abnormal skeletal geometry – such as increased femoral anteversion, trochlear dysplasia, patella alta or...
Trochlear dysplasia is defined as abnormal shape of the trochlea. It can be shallow, flat, or convex (Fig. 35.1.This anatomic status fails to provide adequate constraint to the normal patellar tracking. Trochlear dysplasia is found in 96% of the populationwith objective patellar dislocation (at least one true dislocation).8 This clearly demonstrates its importance in the genesis of the instability.
An abnormal increase in external tibial torsion was one of the components of the “Miserable Malalignment” syndrome described by Stan James in 1979.10 It is becoming recognized that these various miserable malalignment components: increased femoral anteversion, squinting patella, genu varum, patella alta, increased Q-angle, external tibial rotation, tibia varum and compensatory pronation of the foot,...
Skeletal alignment in all three planes has a great influence on patellar tracking and loading. The source of patellofemoral loading is extraarticular; this is the reason that operations limited to the knee joint frequently fail if this is not recognized. The treatment of skeletal malalignment requires the correct bony operation. If there is genu valgum because of a short lateral femoral condyle, a...
Patella infera represents the low position of the patella in relation to the femur and the tibia. Two terminologies are used to qualify this low position of the patella: “patella baja” or “patella infera.” As the Latin form is the common way to describe the high position of the patella (patella alta), it is coherent to define patella infera as the appropriate term. Evocated for the first time by A...
The etiology of the patellar instability involves multiple factors and it can often be successfully managed with conservative treatment. This is particularly so in cases of primary dislocation. If there is no clinical improvement with nonoperative management, surgery may be considered especially in cases of recurrent patellar dislocation. In these patients, a complete physical examination and some...
The tibial tubercle (interchangeable with tuberosity) is the most distal anchor of the extensor mechanism and can serve as a tool in altering patellofemoral (PF) mechanics. Known collectively as distal realignment procedures, osteotomies of the tibial tubercle are a useful method to treat a variety of PF conditions by allowing coronal, axial, and sagittal plane adjustments of the patellofemoral articulation...
Isolated patellofemoral osteoarthritis (PFOA) is a relatively common and disabling disease. While its radiological incidence is as high as 24% in women and 11% in men aged over 55, it becomes symptomatic in 8% of the women and 2% of the men in this age group.
The treatment of patellofemoral (PF) articular cartilage pathology is difficult because the pathology is multifactorial and symptoms related to the cartilage portion of the problem are expressed through noncartilaginous tissue. Since cartilage is aneural, the symptoms from the cartilage defects are mediated through the mechanical effects on bone and by cartilage debris that causes noxious stimulation...
“Modern resurfacing techniques” try to produce a hyaline or hyaline-like surface in the region of a localized, full-thickness cartilage defect. Autologous osteochondral mosaic transplantation technique is one of the recently evolved methods to create hyaline or hyaline-like repair tissue in the pathologic area. During this procedure small-sized osteochondral plugs covered with healthy hyaline cap...
If the articular cartilage has been lost and osteoarthritis develops, two alternatives are available: (1) restoration of the normal extra-articular anatomy and stability, and (2) replacement of the articular cartilage. Options for articular cartilage replacement are biologic or prosthetic.
There has been a proliferation of new patellofemoral implants, which reflects an increasing interest in this topic on the part of the orthopedic community. The procedure is a niche procedure reserved for patients with isolated patellofemoral arthritis who are unlikely to develop femorotibial arthritis in their lifetime, and for patients considered too young or too active to receive a total knee replacement...
Unfortunately, many orthopedic surgeons believe that the definite solution for eliminating anterior knee pain in a young patient with multiple operations is the patellofemoral prosthesis (“The Great Solution”). But, they fail to ask themselves the most important question; what is causing the pain? When a patellofemoral prosthesis is implanted in these young patients without finding out the cause of...