Video Gallery

Video Gallery

To View the Video

Medial Patello-Femoral Ligament Reconstruction - A Simple, All Soft Tissue, Implant-Free, Complete Anatomic "Basket Weave" Technique Suitable for All Age Groups

February 10, 2018

Contributors: Pranjal Kodkani, MBBS, MD, MS; Pranjal Kodkani, MBBS, MD, MS

The medial patellofemoral ligament (MPFL) is the primary medial static stabilizer of the patella, restraining lateral patellar instability. In patients with a traumatic patellar dislocation, a symptomatic laterally subluxating patella, or a recurrent patellar dislocation, the MPFL is functionally insufficient. This is best managed via MPFL reconstruction. A detailed study of the complex anatomy of the MPFL reveals that the uppermost fibers do not have a bony insertion over the medial border of the patella. These upper fibers decussate into the vastus intermedius and, therefore, have a soft-tissue insertion. This portion of the MPFL complex is called the medial quadriceps tendon femoral ligament. MPFL reconstruction methods that involve the use of bone tunnels and implant fixation compromise outcomes because of rigid fixation and nonanatomic reconstruction as they do not include the medial quadriceps tendon femoral ligament, which has a soft-tissue insertion. Bone tunnels and implants are prone to complications and result in suboptimal outcomes in the patella/femur. These methods are not advisable in skeletally immature patients and are not associated any proprioceptive advantage because of direct bone fixation without soft-tissue attachment. The use of intraoperative radiography has further compromised outcomes because it is associated with intraoperative errors. The basket-weave technique for MPFL reconstruction was devised to overcome the deficiencies associated with other MPFL reconstruction techniques and to avoid the use of bone tunnels and implants and their associated complications. In addition, the basket-weave technique does not involve the use of intraoperative radiography and results in complete anatomic reconstruction (in the patella and femur). The technique affords a physiometric construct using differential tensioning of the hamstring graft with a pure soft-tissue fixation. This replicates normal physiologic tensioning of the MPFL in its superior and inferior region at varying degrees of flexion. Therefore, the technique can restore normal physiologic stability and mobility of the patella throughout range of motion. In a prospective study on the basket-weave technique, no major complications were encountered. The results of the basket-weave technique were substantially better than those reported in any other case series on MPFL reconstruction using other techniques. The basket-weave technique for MPFL reconstruction is associated with several advantages. The technique is completely anatomic; affords a physiometric construct (reproducing normal physiologic tensioning and biomechanics of a normal MPFL); affords better proprioception; avoids overconstrain; is the least invasive MPFL reconstruction technique because it does not require the use of bone tunnels or implants; avoids radiographic errors; can be performed in skeletally immature patients, patients with a hypoplastic patella, and patients who have undergone patellofemoral arthroplasty; does not compromise revision surgery, if necessary; and is an economical procedure. Studies have shown that the basket-weave technique is a reliable, reproducible procedure that results in excellent outcomes and a low rate of complications. Therefore, the technique may be preferred for MPFL reconstruction if indicated.

Results for "Pediatric Orthopaedics"

1 of 6
1 of 6

X