Besides mpfl reconstruction failure due to an incorrect surgical indication, inappropriate surgical technique andor patient selection, several biomechanical studies have demonstrated that the femoral grafttunnel position is the most important factor. We present a relatively simple surgical technique of mpfl recon struction using a. The medial patellofemoral ligament mpfl provides the main restrain against lateral patellar dislocation and displacement. May 11, 2014 medial patellofemoral ligament mpfl reconstruction 2014 1. Rehabilitation guidelines for medial patellofemoral ligament repair and reconstruction the knee consists of four bones that form three joints. Pdf background primary patellofemoral dislocations are common. However, surgical treatment in skeletally immature patients is still a subject of discussion. I was wondering if you experienced any pain this late in the rehab. Jul 11, 20 surgical video of a medial patellofemoral ligament mpfl reconstruction performed by dr. In all 4 knees, the mpfl reconstruction was isolated and was not associated with any other realignment procedures.
Mpfl tech mpfl reconstruction for patellar instability. Mpfl tech mpfl reconstruction for patellar instability 1. Medial patellofemoral ligament is a band of tissue that extends from the femoral medial epicondyle to the superior aspect of the patella. The patella attaches with the femur bone and forms the patellofemoral joint. Knee medial patellofemoral ligament reconstruction technique. Cosgarea the medial patellofemoral ligament mpfl has garnered attention in the literature as the primary static ligamentous checkrein, preventing lateral patellar subluxation andor dislocation. Reconstruction of the mpfl can yield successful outcomes, but errors in patient selection, technical problems and nonconsideration of additional risk factors were found to. Patella stabilization patellofemoral ligament reconstruction. Light resistance leg press less than 90 degrees knee flexion, abductionadduction hip machines at the gym. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. By metcalf memorial meeting 2010 featuring ganesh kamath.
Surgical anatomy and reconstruction technique to prevent patella instability john p. The doublebundle technique also effectively limits rotation throughout rom, helping to minimize postoperative instability. Medial patellofemoral ligament reconstruction is the most frequently. Verma or either physician assistant supersede the instructions below and should be followed. Moreover, the complicationrateof26%associatedwith mpfl reconstruction is not trivial. The purpose of this study is to describe the short term results of a new minimally invasive mpfl reconstruction technique using the. The purpose of this study is to compare the results of both surgical techniques for mpfl reconstruction with a minimum of twoyear followup.
Surgical reconstruction of the medial patellofemoral ligament. Mpfl reconstruction with autologous gracilis tendon using the. The mpfl is often damaged during patellar subluxation or dislocation, and accordingly, over the last decade, several authors have recommended repair or reconstruction of the mpfl to reduce the high incidence of recurrent dislocation, and many different mpfl surgical reconstruction or repair techniques have been described in the literatures5. It is estimated that the mpfl resists 53% to 60% of the force required to.
Mpfl surgical technique using hamstring autograft with suture anchor fix. We describe a simple technique of mpfl reconstruction using a. Medial patellofemoral ligament reconstruction using hamstring autograft in children and adolescents. Reconstruction of the medial patellofemoral ligament. Medial patello femoral ligament mpfl reconstruction with. Patellar instability surgery in clinical practice vicente sanchis. We describe a mpfl reconstruction procedure where bonefascia tunnel fixation occurs at the medial margin of the patella for recurrent patellar dislocation. These include medial patellofemoral ligament mpfl reconstruction, tibial tubercle osteotomy tto, and trochleoplasty. Medial patellofemoral ligament reconstruction kogarah nsw. We describe a simple technique of mpfl reconstruction using a single hamstring tendon graft which is passed through the medial. This modified technique avoids the distal femoral growth plate, minimizes the risk of injury, and allows a safe, effective, and anatomic treatment option tables 1 and 2. This is determined by a detailed clinical assessment of your qangle and jsign and xray measurement of your tibial tubercle to trochlear groove tttg distance. Mpfl reconstruction with autologous gracilis tendon using the two bone tunnel technique this surgical technique was prepared under the guidance of prof.
Mpfl reconstruction for patellar instability dr shekhar srivastav sr. May 12, 2018 to discuss the potentially significant complications associated with medial patellofemoral ligament mpfl reconstruction. Review article guidelines for medial patellofemoral. What are some of the technique modifications you have made as. Postop instructions for mpfl reconstruction patellar. Mpfl reconstruction indications and technical principles. If the dislocation recurs after a trial of rehabilitation, operative intervention is considered, with. Remove surgical dressings 23 days after your surgery. Medial patellofemoral ligament mpfl reconstruction. The video demonstrates a patella or kneecap dislocation and how it is surgically treated. Open anatomic reconstruction of the medial collateral.
The mpfl reconstruction can be performed either isolated or in association with trocleoplasty and att transfer. Mpfl reconstruction with autologous gracilis tendon using. Rehabilitation guidelines for medial patellofemoral ligament. Our preferred technique for anatomic medialsided knee reconstruction is an open anatomic mcl reconstruction using an. Nm is the senior author who has developed the surgical. Doublebundle medial patellofemoral ligament reconstruction with allograft.
Smith shows how the mpfl reconstruction can be an ideal minimally invasive technique option by explaining graft preparation, the use of the surgical template to find the anatomic insertion point, graft placement, and fixation. An anatomical mpfl reconstruction should be the goal of surgical intervention in cases of patellofemoral. Mpfl reconstruction for recurrent patella dislocation. Questions if you have any concerns or questions after your surgery, during business hours call 7633022231.
Isolated cases failing nonoperative treatment may also undergo surgical treatment. Mpfl reconstruction surgery canbe combined with a lateral retinacular release, tibial tuberosity medialization elmslietrillat osteotomy or anteromedialization fulkerson osteotomy. The patella knee cap is a protective bone attached to the quadriceps muscles of the thigh by the quadriceps tendon. Jul 22, 2016 indications and technique for mpfl reconstruction derek f. Mr gilbert and mr coupe sports knee clinic wrightington. Knee mpfl repair 1 overview this is a protocol that provides you with general information. Mpfl reconstruction surgical technique guide medshape, inc.
Smith shows how the mpfl reconstruction can be an ideal minimally invasive technique option by explaining graft preparation, the use of the surgical template to find the anatomic insertion point, graft placement, and. Pdf mpfl reconstruction for recurrent patella dislocation. Mpfl reconstruction mersey patella dislocation surgery. Medial patellofemoral ligament mpfl reconstruction surgery is performed by orthopedic surgeon dr sivaram rajan in hackensack, newark and jersey city, new jersey.
Medial patellofemoral ligament mpfl reconstruction is a common procedure used to treat both acute and chronic patellar instability. Many surgical techniques, both proximal and distal, have been used with varying. Sep 03, 2015 mpfl tech mpfl reconstruction for patellar instability 1. Medial patellofemoral ligament reconstruction is the knee cap condition treated at sydney knee specialists in kogarah and sydney nsw. Review article guidelines for medial patellofemoral ligament. Mpfl reconstruction using a quadriceps tendon graft. Sports girl recovers quickly from mpfl surgery a country. My posts about my 14yearold daughters knee surgery where surgeons used a cadaver ligament to replace her mpfl and a lateral release have attracted lots of readers and several comments. Lateral patellofemoral instability is characterized by a deficiency of the medial patellofemoral retinacular soft tissues due to ligamentous laxity andor injury. Arthroscopy assisted mpfl reconstruction by anatomic. Dynamic medial patellofemoral ligament reconstruction in. Hi, i had mpfl reconstruction in october of 2017 and everything was going great but now its month 9 and i am experiencing extreme pain and i am not able to make it through physical therapy or run.
In recent years the surgery has evolved considerably as the anatomy and goals of reconstruction have become more defined. Multiple cadaveric studies have characterized the anatomy of the mpfl and the related morphologic. Surgical video of a medial patellofemoral ligament mpfl reconstruction performed by dr. Mpfl reconstruction for patellar instability in younger. These techniques are not as effective in preventing recurrence of dislocation as reconstruction of the mpfl. Surgical technique and postoperative protocol initially diagnostic arthroscopy of the affected knee was performed to identify the mpfl tear and to rule out any other associated pathology or other ligament tear. Aug 15, 2014 medial patellofemoral ligament mpfl reconstruction has become an accepted technique to treat patellofemoral instability, and numerous surgical techniques have been described to reconstruct the mpfl. Medial patello femoral ligament mpfl reconstruction with autologous gracilis tendon using the two bone tunnel technique this surgical technique was prepared under the guidance of prof. Rehabilitation of the knee after medial patellofemoral ligament reconstruction donald c.
However, since it is known that a nonanatomic reconstruction of the mpfl can lead to nonphysiologic patellofemoral loads and kinematics1, the goal of surgical intervention must be an anatomic reconstruction. We report an mpfl reconstruction technique using a free hamstring autograft. Up to now, hamstring grafts are far more common for mpfl reconstruction than quadriceps tendon techniques. To discuss the potentially significant complications associated with medial patellofemoral ligament mpfl reconstruction. Medial patellofemoral ligament reconstruction is a surgical procedure indicated in patients with more severe patellar instability. Although many variations of mpfl reconstruction have been described, there is no consensus regarding the optimal surgical technique. Mpfl reconstruction rehabilitation the following is a protocol for postoperative patients following medial patellofemoral ligament reconstruction. Progress knee bending stretches with self assisted technique strap, other leg, wall, etc. Medial patellofemoral ligament reconstruction using. We describe a mpfl reconstruction procedure where bonefascia tunnel fixation occurs at the medial margin of the patella for recurrent patellar. Postop instructions for mpfl reconstruction patellar stabilization please note that these instructions are general guidelines to be followed.
It offers an excellent treatment option for people who have experienced more than one dislocation. Mpfl reconstruction as single procedure holds high risk of. The arthrex anatomic doublebundle technique for medial patellofemoral ligament mpfl reconstruction replicates the native shape of the mpfl and provides stability in both flexion and extension. Videos surgical technique medial patellofemoral ligament reconstruction. Mpfl reconstruction is a surgery in which a new medial patellofemoral ligament is created to stabilize the knee and help protect the joint from additional damage.
What are some of the technique modifications you have made as you have gained. Chens surgical technique for doublebundle medial patellofemoral ligament reconstruction with allograft has been featured in arthroscopy techniques the journal of arthroscopic and related surgery. Sulcusdeepening trochleoplasty and mpfl reconstruction. Multiple cadaveric studies have characterized the anatomy of the mpfl and the related morphologic abnormalities that contribute to recurrent lateral. Browse more than 12,000 surgery videos and save your favorites for free. Medial patellofemoral ligament mpfl reconstruction using. David flanigan, md the ohio state university clinical orthopaedics columbus, oh the views expressed here are my own and not those of my employer.
Knee medial patellofemoral ligament reconstruction. As an alternative to hamstring tendon grafts for mpfl reconstruction, surgical techniques using. Mpfl reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. Steinthe docking technique for medial patellofemoral ligament reconstruction. Initiate weight shifting, shortarc knee bends, mini steps ups, and proprioceptive exercises. Mpfl reconstruction techniques differ in the graft used and the fixation method. Several surgical techniques have been described for the mpfl reconstruction, using many femoral and patellar fixation techniques and different grafts autograft, allograft, synthetic1215.
Both medial patellofemoral ligament reconstruction techniques had similar. The reconstruction was done with the use of hamstring autograft. Rehabilitation of the knee after medial patellofemoral. Reconstruction of the mcl and posteromedial corner is indicated in the setting of a multiligamentous knee injury. Based upon individual pathology, each technique will have slight variations in the rehabilitation protocol. Mpfl is the major ligament which stabilizes the patella and helps in preventing patellar subluxation partial dislocation or dislocation. Medial patellofemoral ligament reconstruction technique for patellofemoral instability as described by. Created under close collaboration with the physician, it contains a. Knee mpfl repair 1 overview this is a protocol that provides you with general information and guidelines for the initial stage and progression of rehabilitation according to the general timeframes. Arthrex medial patellofemoral ligament reconstruction. Mpfl reconstruction surgery penrith knee cap surgery. Mpfl reconstruction surgery video orthopedic surgery video. Locked in extension for ambulation wbat in extension, open 090.
Medial patellafemoral ligament mpfl reconstruction is a procedure used to correct serious and recurring dislocation of the kneecap. This technical note presents a surgical technique to identify the insufficient mpfl and describes in detail an anatomical retensioning repair of the mpfl to restore patellar stability. Tamara l young, atc, otc, med department of sports medicine diagnosis. The outcomes are inconsistent and many studies have reported recurrent dislocations and patellofemoral pain and arthritis in up to 40%. In mpfl reconstruction, the torn mpf ligament is removed and reconstructed using a grafting technique. The technique of noyes and albright is by definition not an mpfl reconstruction, but a reinforcement of the medial retinaculum with a qt graft.
Mpfl reconstruction has become an accepted surgical technique for the restoration of patellofemoral stability. Medial patellofemoral ligament reconstruction using a. Pdf medial patellofemoral ligament reconstruction researchgate. Indications and technique for mpfl reconstruction derek f. Created under close collaboration with the physician, it contains a summary of medical techniques and opinions based upon her training and expertise. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. The femur is the large bone in the thigh and attaches by ligaments and a capsule to the tibia, the large bone in the lower leg commonly referred to as the shin bone. Patellofemoral ligament reconstruction rehabilitation program. We report an mpfl reconstruction technique using a free hamstring autograft, docking it distally to the distal femoral epiphysis and by 2 sockets at the patella. Medial patellofemoral ligament reconstruction east melbourne. Avoiding complications with mpfl reconstruction springerlink.
Mpfl repairreconstruction rehabilitation protocol seth l. Medial patellofemoral ligament reconstruction is a commonly performed procedure for patellofemoral instability. Rehabilitation guidelines for medial patellofemoral. Medial patellofemoral ligament mpfl reconstruction 2014. Medial patellofemoral ligament mpfl reconstruction 2014 1. I am happy to report that sports girl continues to have a quick and painless recovery. Powers, phd, ptd,e, najeeb khan, mdb,c rehabilitation of the extensor mechanism after patellar stabilization surgery should be. Most frequently surgical reconstruction of the mpfl is performed to address patellar instability. We describe a simple technique of mpfl reconstruction using a single hamstring. The procedure that is most frequently performed to treat lateral patellar. Medial patellofemoral ligament reconstruction using hamstring. This has resulted in numerous surgical options involving various fixation devices. They will be described here as a function of their fixation method, either into. Mpfl repairreconstruction protocol missouri orthopaedic institute mpfl repairreconstruction rehabilitation protocol seth l.
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