Michael Saper, D.O. Arthroscopy Techniques

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Lateral Patellofemoral Ligament Reconstruction With a Gracilis Allograft Michael Saper, D.O. Arthroscopy Techniques Volume 7, Issue 4, Pages e405-e410 (April 2018) DOI: 10.1016/j.eats.2017.10.014 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Left knee viewed from the anterolateral portal with a 30° arthroscope. Medial patellar subluxation at 30° of knee flexion is clearly visualized. Arthroscopy Techniques 2018 7, e405-e410DOI: (10.1016/j.eats.2017.10.014) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 A 3- to 4-cm midline skin incision is made centered over the superior one third of the patella. (A) A 1-cm incision is placed in the periosteum at the level of the proximal patella. (B) A second 1-cm incision is made at the lateral border of the patella. (C) The 2 incisions are connected subperiosteally (left knee). Arthroscopy Techniques 2018 7, e405-e410DOI: (10.1016/j.eats.2017.10.014) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 The appropriate location for the LPFL femoral attachment at the lateral epicondyle is identified, and a small 2- to 3-cm longitudinal incision is made at that site to allow for tunnel placement. Using a long, curved clamp, the selected soft-tissue interval is developed in the lateral retinaculum from the edge of the patella to the lateral epicondyle (left knee). Arthroscopy Techniques 2018 7, e405-e410DOI: (10.1016/j.eats.2017.10.014) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 (A) The tip of a 2.7-mm passing pin is placed at the lateral epicondyle; the pin is directed slightly anteriorly then advanced toward the medial side of the femur. (B) A blind tunnel is then reamed into the femur the size of the doubled graft (left knee). Arthroscopy Techniques 2018 7, e405-e410DOI: (10.1016/j.eats.2017.10.014) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 The gracilis allograft is looped through the subperiosteal tunnel. With a passing suture, the free ends of the graft are then passed through the retinacular tunnel exiting at the epicondyle (left knee). Arthroscopy Techniques 2018 7, e405-e410DOI: (10.1016/j.eats.2017.10.014) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 The periosteum is sutured to the graft, and then the retinaculum is closed over the graft with nonabsorbable suture (left knee). Arthroscopy Techniques 2018 7, e405-e410DOI: (10.1016/j.eats.2017.10.014) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions