Justin L. Makovicka, M. D. , David E. Hartigan, M. D. , Karan A

Slides:



Advertisements
Similar presentations
Reconstruction of the Medial Patellofemoral Ligament
Advertisements

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction  Adrian Todor, M.D., Ph.D., Sergiu.
Alexander Haupert, M.D., Olaf Lorbach, M.D., Ph.D. 
Bertrand Sonnery-Cottet, M. D. , Matt Daggett, D. O. , M. B. A
Combined Reconstruction of the Medial Collateral Ligament and Anterior Cruciate Ligament Using Ipsilateral Quadriceps Tendon–Bone and Bone–Patellar Tendon–Bone.
Protection of the Medial Femoral Condyle Articular Cartilage During Drilling of the Femoral Tunnel Through the Accessory Medial Portal in Anatomic Anterior.
Steven Shamah, B. S. , Daniel Kaplan, B. A. , Eric J. Strauss, M. D
Justin L. Makovicka, M. D. , David E. Hartigan, M. D. , Karan A
Multiligament Reconstruction of the Knee in the Setting of Knee Dislocation With a Medial-Sided Injury  Marcio B. Ferrari, M.D., Jorge Chahla, M.D., Justin.
Suspensory Anterior Tibial Fixation in the Anatomic Transtibial Posterior Cruciate Ligament Reconstruction  Ashraf Elazab, M.D., M.Sc., Yong Seuk Lee,
Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique 
Femoral Fixation With Curve Cross-Pin System in Arthroscopic Posterior Cruciate Ligament Reconstruction  Ezio Adriani, M.D., Berardino Di Paola, M.D.,
Alexander Haupert, M.D., Olaf Lorbach, M.D., Ph.D. 
Posterior Cruciate Ligament Reconstruction With Hamstring Tendons Using a Suspensory Device for Tibial Fixation and Interference Screw for Femoral Fixation 
Ahmad M. Wagih, M.D., M.R.C.S., F.E.O.B., Ahmed M.F. Elguindy, M.D. 
Assem Mohamed Noureldin Zein, M. D. , Mohamed Elshafie, M. D
Distal Clavicle Fracture Repair Using Cortical Button Fixation With Coracoclavicular Ligament Reconstruction  Gautam P. Yagnik, M.D., David A. Porter,
Self-flip Technique of the TightRope RT Button for Soft-Tissue Anterior Cruciate Ligament Reconstruction  Kengo Harato, M.D., Ph.D., Yasuo Niki, M.D.,
Anatomic Medial Patellofemoral Ligament Reconstruction Without Bone Tunnels or Anchors in the Patella  Yehia H. Bedeir, M.B.B.Ch., M.Ch.(Orth), Melissa.
Minimally Invasive Anterolateral Ligament Reconstruction of the Knee
Combined Anatomic Reconstruction of the Anterior Cruciate and Anterolateral Ligaments Using Hamstring Graft Through a Single Femoral Tunnel and With a.
A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device  Shaneel Deo, B.H.B.(Hons), M.B.Ch.B.,
Medial Patellofemoral Ligament Reconstruction With a Looped Semitendinosus Tendon, Using Knotless Anchor Fixation on the Patella and Hybrid Fixation on.
Minimally Invasive Quadriceps Tendon Harvest and Graft Preparation for All-Inside Anterior Cruciate Ligament Reconstruction  Harris S. Slone, M.D., William.
Posterior Cruciate Ligament Reconstruction with Retrograde Femoral Technique, Posterior Trans-septal Portal and Full Tibial Tunnel  Man Soo Kim, M.D.,
The Quad Link Technique for an All-Soft-Tissue Quadriceps Graft in Minimally Invasive, All-Inside Anterior Cruciate Ligament Reconstruction  Gregory R.
Emily Harnden, M. D. , Timothy Lin, M. D. , M. S. , Adam Wilson, M. D
Arthroscopic Iliopsoas Release at the Level of the Lesser Trochanter Following Total Hip Arthroplasty  Karan A. Patel, M.D., Anikar Chhabra, M.D., Jill.
Jonathan A. Godin, M. D. , M. B. A. , Vasili Karas, M. D. , M. S
Biologically Augmented Quadriceps Tendon Autograft With Platelet-Rich Plasma for Anterior Cruciate Ligament Reconstruction  Jorge Chahla, M.D., Ph.D.,
Anatomic Arthroscopic Ligamentum Teres Reconstruction for Hip Instability  Travis J. Menge, M.D., Justin J. Mitchell, M.D., Karen K. Briggs, M.P.H., Marc.
Anatomic Posterolateral Corner Reconstruction Using Single Graft Plus Adjustable-Loop Suspensory Fixation Device  Ryan Wood, B.M.B.Ch., M.A., F.R.C.S.
Combined Anterior Cruciate Ligament, Medial Collateral Ligament, and Posterior Oblique Ligament Reconstruction Through Single Tibial Tunnel Using Hamstring.
Pierre Imbert, M. D. , Philippe D'Ingrado, M. D. , Maxime Cavalier, M
Anatomic Outside-In Anterior Cruciate Ligament Reconstruction Using a Suspension Device for Femoral Fixation  Alejandro Espejo-Baena, M.D., Alejandro.
Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction by Hamstring Tendon Autografts Through a Single Femoral Tunnel by Graft-to-Graft.
Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal  Stephen E.
Karan A. Patel, M. D. , David E. Hartigan, M. D. , Justin L
Patella Footprint Technique—A Surgical Method for Medial Patellofemoral Ligament Reconstruction  Jennifer Kurowicki, M.D., Samuel J. Mease, M.D., Steven.
Arthroscopic Posterior Cruciate Ligament Reconstruction With Remnant Preservation Using a Posterior Trans-septal Portal  Dhong Won Lee, M.D., Hyeuk Woo.
Shuji Nakagawa, M. D. , Ph. D. , Yuji Arai, M. D. , Ph. D
James D. Wylie, M.D., M.H.S., Robert T. Burks, M.D. 
Medial Patellofemoral Ligament Reconstruction in a Revision Setting: Anchor and Interference Screw Fixation  Marcio B. Ferrari, M.D., George Sanchez,
Masato Takao, M. D. , Ph. D. , Mark Glazebrook, M. D. , M. Sc. , Ph. D
Intra-articular Anterior Cruciate Ligament Reconstruction With Extra-articular Lateral Tenodesis of the Iliotibial Band  João Luiz Ellera Gomes, M.D.,
Medial Patellofemoral Ligament Reconstruction: A New Technique for Graft Fixation at the Patella Without Implants  Sven Shafizadeh, M.D., Maurice Balke,
Pierre Imbert, M. D. , Philippe D'Ingrado, M. D. , Maxime Cavalier, M
Patrick A. Smith, M.D., Jordan A. Bley, B.A.  Arthroscopy Techniques 
Concomitant Arthroscopic Meniscal Allograft Transplantation and Anterior Cruciate Ligament Reconstruction  Bryan M. Saltzman, M.D., Justin W. Griffin,
Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents Using a Pedicled Quadriceps Tendon Graft  Manfred Nelitz, M.D.,
Michael G. Saper, D.O., A.T.C., C.S.C.S., David A. Shneider, M.D. 
All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Surgical Technique Using a Split Tibial Tunnel  Marios G.
Posterior Cruciate Ligament Reconstruction with Retrograde Femoral Technique, Posterior Trans-septal Portal and Full Tibial Tunnel  Man Soo Kim, M.D.,
Michael Saper, D.O.  Arthroscopy Techniques 
Jannik Frings, M. D. , Jan P. Kolb, M. D. , Tobias C. Drenck, M. D
Karan A. Patel, M. D. , David E. Hartigan, M. D. , Justin L
Augmentation of Anterior Cruciate Ligament Reconstruction With Bone Marrow Concentrate and a Suture Tape  Chad Lavender, M.D., Brock Johnson, M.D., Adam.
Minimally Invasive Quadriceps Tendon Harvest and Graft Preparation for All-Inside Anterior Cruciate Ligament Reconstruction  Harris S. Slone, M.D., William.
Simultaneous Medial and Lateral Patellofemoral Ligament Reconstruction for Combined Medial and Lateral Patellar Subluxation  Michael G. Saper, D.O., David.
Giacomo Zanon, M.D., Matteo Marullo, M.D., Francesco Benazzo, M.D. 
Christopher L. Camp, M. D. , Joshua S. Dines, M. D. , Pramod B
Emily Harnden, M. D. , Timothy Lin, M. D. , M. S. , Adam Wilson, M. D
Robert Petretta, M.D., F.R.C.S.C., Vipul Mandalia, M.B.B.S, F.R.C.S.C. 
Hassan Azimi, M.D., Oke Anakwenze, M.D.  Arthroscopy Techniques 
Krzysztof Hermanowicz, M. D. , Ph. D. , Konrad Malinowski, M. D. , Ph
Steven Shamah, B. S. , Daniel Kaplan, B. A. , Eric J. Strauss, M. D
Medial Patellofemoral Ligament Reconstruction With a Looped Semitendinosus Tendon, Using Knotless Anchor Fixation on the Patella and Hybrid Fixation on.
Patrick A. Smith, M.D., Jordan A. Bley, B.A.  Arthroscopy Techniques 
Combined Reconstruction of the Medial Collateral Ligament and Anterior Cruciate Ligament Using Ipsilateral Quadriceps Tendon–Bone and Bone–Patellar Tendon–Bone.
Arthroscopic Iliopsoas Release at the Level of the Lesser Trochanter Following Total Hip Arthroplasty  Karan A. Patel, M.D., Anikar Chhabra, M.D., Jill.
Presentation transcript:

Medial Patellofemoral Ligament Reconstruction Using All-Soft Suture Anchors for Patellar Fixation  Justin L. Makovicka, M.D., David E. Hartigan, M.D., Karan A. Patel, M.D., Sailesh V. Tummala, B.S., Anikar Chhabra, M.D., M.S.  Arthroscopy Techniques  Volume 7, Issue 3, Pages e231-e237 (March 2018) DOI: 10.1016/j.eats.2017.08.075 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Lateral (A), medial (B), and end-table (C) views of operating room setup in preparation for medial patellofemoral ligament reconstruction. The patient is supine with the knee at 90°. The post and sterile draping can be set up as per the surgeon's preference. Arthroscopy Techniques 2018 7, e231-e237DOI: (10.1016/j.eats.2017.08.075) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Lateral (A) and medial (B) views of outlined patellar and femoral incisions, along with standard anterolateral and anteromedial arthroscopy portals. A longitudinal line is drawn along the medial border of the patella with the knee in extension. The knee is then flexed to 90°, and a longitudinal line at the location of the medial epicondyle is drawn parallel to the first line for the femoral incision, both approximately 3 cm in length. Arthroscopy Techniques 2018 7, e231-e237DOI: (10.1016/j.eats.2017.08.075) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 A diagnostic arthroscopy is performed addressing all concomitant pathology with particular attention paid to the patellofemoral joint pathology, alignment, and need for treatment. An arthroscopic view of the patellofemoral joint with visualization of the attenuated medial patellofemoral ligament (MPFL) can be seen. Arthroscopy Techniques 2018 7, e231-e237DOI: (10.1016/j.eats.2017.08.075) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Once the medial patellar incision is exposed bluntly down to the retinaculum, it is incised in line with the skin incision approximately 2 to 3 mm off the border of the patella (A) and a T-incision is then made at the one-third–two-thirds junction of the proximal patella (B). Care must be taken not to incise the joint capsule. Arthroscopy Techniques 2018 7, e231-e237DOI: (10.1016/j.eats.2017.08.075) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 (A) The proximal anchor site is drilled in the trough at the one-third–two-thirds junction of the proximal patella, and a 1.8-mm Q-Fix anchor is placed at the proximal anchor site. (B) A second 1.8-mm Q-Fix anchor is placed 0.75 cm distally to the first. Arthroscopy Techniques 2018 7, e231-e237DOI: (10.1016/j.eats.2017.08.075) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 Once the graft is thawed and cut to the appropriate length, the long limb of each suture anchor is whipstitched to 1 end of the graft (A) and the short limb of the suture is then pulled to cinch the graft into the bone trough (B). (C) After both ends are fixed and tied into the trough, a looped graft with 2 limbs on the patella is created, simulating the anatomic insertion of the native medial patellofemoral ligament on the patella. Arthroscopy Techniques 2018 7, e231-e237DOI: (10.1016/j.eats.2017.08.075) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 7 (A) Once the femoral incision is dissected down to the medial epicondyle, the knee is flexed to approximately 90° and fluoroscopy is used to isolate the Schöttle point on a perfect lateral radiograph. (B) This point (star) is located approximately 1 mm anterior to the posterior cortex of the femur, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior point of the Blumensaat line. Arthroscopy Techniques 2018 7, e231-e237DOI: (10.1016/j.eats.2017.08.075) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 8 In approximately 30° of flexion, tension is pulled on the graft through the lateral side and the graft is fixed into place with a BioComposite interference screw 1 size larger than the diameter of the tunnel. It should be noted that during tensioning, a Kocher clamp is placed underneath the graft at the medial incision site to prevent over-tightening. Arthroscopy Techniques 2018 7, e231-e237DOI: (10.1016/j.eats.2017.08.075) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions