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DVD-2003 | A | MPFL Reconstruction

Philip Schöttle

Human

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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MPFL Reconstruction

Gracilis tendon autograft is routinely used for mpfl reconstruction, as size and strength characteristics are ideal for this indication. The tendon is retrieved through a small incision over the insertion, and a tendon stripper is used to harvest the graft. A tendon length of 18 to 20cm is ideal for double bundle mpfl. Reconstruction. Muscle tissue is removed from the tendon. The graft is sutured with a number two FiberLoop to a length of ten millimeters at both ends. A two centimeter skin incision is made along the medial edge of the patella, extending from the superomedial corner to the center of the patella. Palpate the medial edge of the patella and dissect through medial patellar periosteum. Place the first drill tip. Guidewire 1 to 2cm distal of the superomedial corner of the patella. Secure the patella on the opposite side by hand to keep its position when advancing the guidewire. A second guidewire is now placed 15 to 20mm distal and parallel to the first wire. Over. Drill the proximal guide wire with a four millimeters cannulated. Drill to a depth of 25mm. Verify that the 25mm mark of the drill is countersunk within the bone, and not only with the soft tissue, as to ensure full seating of the SwiveLock anchor within the socket. Repeat this procedure for the second guide wire as well. The final construct of the graft is shown here, with each end whip stitched to ten millimeters and the graft folded into half. Remove the proximal guide wire from the socket. Pass the sutures of one graft end through the eyelet of the first 4.75mm SwiveLock, and pull the graft up to the eyelet. The graft anchor construct is pushed into the proximal socket until the eyelet is fully seated. Keep the suture limbs under tension and screw the SwiveLock. Anchor clockwise into the patella until it is flush with the bone. The first graft limb has now been fixed in the patella. Remove FiberWire from the SwiveLock and take it off the insertion handle. Repeat the procedure with the second graft limb in the same manner. After final fixation, the whipstitch sutures may be cut off. Verify stability and strength of the two bundle construct by pulling on graft loop. Identify the space between the vastus medialis and the capsule and bluntly dissect towards the femoral insertion area with the scissor leaving the capsule intact. A grasper is inserted into the prepared layer and placed in the area between the medial epicondyle and the abductor tubercle. At this position, a longitudinal skin incision of approximately one centimeter is performed in 30 degrees of knee flexion. A shuttle suture is looped into the prepared layer from the femoral to the patellar insertion. A guidewire is placed at the anatomical femoral insertion of the mpfl. Use the tip of the guidewire to palpate the palpate the medial epicondyle and the abductor tubercle. A six millimeter cannulated drill is inserted over the guidewire down to the medial cortex. The femoral insertion point is now verified under fluoroscopy on a straight lateral view. The insertion point is approximately one millimeter anterior to the continuation of the posterior cortex. 2.5mm distal to the posterior origin of the medial femoral condyle and proximal to the level of blumenstrasse line on a lateral radiograph, with both posterior condyles projected in the same plane. It is strongly recommended to verify this position by fluoroscopy, as a non anatomical fixation can lead to an increased patellofemoral pressure. Postoperatively. After the correct insertion is achieved, the guidewire is drilled out of the lateral thigh and over drilled with a six millimeters cannulated drill up to the contralateral cortex. Keep the guidewire in place and secure it with a chuck handle on the lateral side. Place a traction suture into the looped end of the graft. Until the graft through the prepared medial layer towards the femoral insertion. In both limbs of the graft uniformly while passing them towards the femoral insertion point of the mpfl. A nitinol guidewire into the drill hole next to the femoral guidewire. Use. Use the eyelet of the guidewire to pull the suture of the looped graft to the lateral side of the femur. Tension the graft gently before pulling into the femur, and ensure that both bundles are kept under equal tension. Pull the graft into the femoral socket. A six by 23mm bioabsorbable interference screw is used to fix the femoral end of the graft. The knee should be held in 30 degrees of flexion during graft fixation. The length of the lateral edge of the patella should be held even with the edge of the lateral trochlea during fixation. Keep the patella in this position by hand while inserting the screw to avoid increased patellofemoral pressure Postoperatively. Finally, the full range of motion is examined while the screwdriver remains in place. The range of motion should be free. And patellar dislocation and or subluxation should not be possible.

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Rekonstruktion des Lig. patellofemorale mediale

MPFL Reconstruction

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Rekonstruktion des Lig. patellofemorale mediale

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