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Knee Surg Sports Traumatol Arthrosc (2010) 18:147151 DOI 10.1007/s00167-009-0868-z
KNEE
Anatomical double-bundle MPFL reconstruction with an aperture xation
Philip B. Schttle Daniel Hensler Andreas B. Imhoff
Received: 17 December 2008 / Accepted: 24 June 2009 / Published online: 11 July 2009 Springer-Verlag 2009
Abstract Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement, reconstruction of the MPFL has become an accepted method of restoring patellofemoral stability and numerous techniques were described. Due to biomechanical examinations and clinical results, an anatomical double-bundle reconstruction of the sail-like MPFL is a reasonable method for achieving stability during complete extension and lower exion degree. This method also serves to avoid rotation of the patella, providing immediate stability throughout the normal range of motion. However, until today, an aperture xation technique at the patellar insertion with two bundles has not been described previously. This technique can provide an immediate stability to allow an early rehabilitation with full range of motion.
Keywords MPFL Patella Instability Double bundle
Aperture xation
Introduction
The medial patellofemoral complex, consisting of the medial patellofemoral ligament (MPFL) and the medial patellotibial ligament, is the main passive stabiliser of the patellofemoral joint. Since it has been shown that rupture of the MPFL is the main pathological consequence of patellar dislocation [4], and biomechanical studies have demonstrated that the MPFL
is the main restraint against lateral patellar displacement, reconstruction of the MPFL has become a widespread technique for restoration of patellofemoral stability. An additional reason that MPFL reconstruction became as popular is the fact that distal realignment procedures such as transfer of the tibial tuberosity or release at the lateral patellar retinaculum/capsule have provided inadequate restoration of patellofemoral stability in every patient, frequently leading to increased mediolateral instability, increased patellofe-moral pressure or arthritic degeneration [5, 6].
Therefore, numerous techniques for reconstruction of the medial patellofemoral complex have been described with promising clinical results [8]. However, since it is known that a non-anatomical reconstruction of the MPFL can lead to non-physiologic patellofemoral loads and kinematics [1], the goal of a surgical intervention must be an anatomical reconstruction. Since the femoral insertion of the MPFL has been evaluated anatomically [1], bio-mechanically [14] and radiologically [12], the complications of increased patellofemoral pressure...