Reconstruction of the Medial Patellofemoral Ligament

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Reconstruction of the Medial Patellofemoral Ligament Juan C. Monllau, M.D., Ph.D., Juan I. Erquicia, M.D., Maximiliano Ibañez, M.D., Pablo E. Gelber, M.D., Ph.D., Federico Ibañez, M.D., Angel Masferrer-Pino, M.D., Xavier Pelfort, M.D., Ph.D. Arthroscopy Techniques Volume 6, Issue 5, Pages e1471-e1476 (October 2017) DOI: 10.1016/j.eats.2017.06.039 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Right knee, anteromedial view. The patient is placed in a supine position on the operating table, with the knee at 90° of flexion. Anteromedial skin incision to harvest the gracilis tendon (GT) using closed tendon stripper (TS). Arthroscopy Techniques 2017 6, e1471-e1476DOI: (10.1016/j.eats.2017.06.039) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Right knee, medial view. A V-shaped tunnel is drilled in the medial aspect of the patella, using a 4.5-mm reamer, leaving a cortical bone bridge of 10 mm between them to avoid a fracture. The medial femoral epicondyle (MFE) and adductor tubercle (AT) are marked. Arthroscopy Techniques 2017 6, e1471-e1476DOI: (10.1016/j.eats.2017.06.039) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Right knee, medial view. Skin incision made along the adductor magnus tendon (AMT). The tendon is identified and dissected. Arthroscopy Techniques 2017 6, e1471-e1476DOI: (10.1016/j.eats.2017.06.039) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Right knee, medial view. Looped suture (LS) placed around the adductor magnus tendon (AMT) for graft passage. Arthroscopy Techniques 2017 6, e1471-e1476DOI: (10.1016/j.eats.2017.06.039) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Right knee, medial view. The gracilis tendon (GT) is introduced in the patellar tunnel. Place the graft in the interval between layers 2 and 3 of the medial retinaculum. The graft should not be deeper than layer 3 so that it remains in the extra-articular environment. Arthroscopy Techniques 2017 6, e1471-e1476DOI: (10.1016/j.eats.2017.06.039) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 Right knee, closer medial view. Graft passed through the patellar V-shaped tunnel, between layers 2 and 3 of the medial retinaculum and looped around the AM tendon back to the patella. Arthroscopy Techniques 2017 6, e1471-e1476DOI: (10.1016/j.eats.2017.06.039) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 7 Both grafts were sutured together at 30° of flexion with no. 0 high-resistance nonabsorbable sutures. Tension was calculated on the basis that the patella could still be manually lateralized some 10 mm to avoid overconstraint. Arthroscopy Techniques 2017 6, e1471-e1476DOI: (10.1016/j.eats.2017.06.039) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions