Name: All-Onlay MPFL Reconstruction
Uploaded: 2026-01-08T00:00:00Z
Channel: Arthrex
Description: Aaron J. Krych, MD (Rochester, MN), demonstrates all-onlay medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL) reconstruction techniques using the MPFL Reconstruction Kit with hybrid Knee FiberTak® anchors.

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INFORMATIONSMATERIALIEN FÜR KUNDEN

Aaron J. Krych, MD (Rochester, MN), demonstrates all-onlay medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL) reconstruction techniques using the MPFL Reconstruction Kit with hybrid Knee FiberTak® anchors.

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VID1-008755-en-US | A | All-Onlay MPFL Reconstruction

Aaron J. Krych

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

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All-Onlay MPFL Reconstruction

Hi everyone. My name is Aaron Critch from Rochester, Minnesota and we're very excited to show you all Onli Mpfl reconstruction today. We're going to do both online fixation for the patella as well as the femur, using our new knee fiber Tak Mpfl reconstruction kit. Let's take a closer look at everything that comes in the knee fiber Tak Mpfl reconstruction kit. The first is the very innovative ratcheting Knee fiber Tak guide that's going to help us place our anchors on the patella. We have a 2.8mm knee fiber tak hard bone drill. We have three hybrid knee fiber tacks. They come on non self punching inserters. What we'll use for online fixation on both the patella as well as the femur. We have our fiber snare to help us with graft passage through our soft tissue layers of the knee. We have our familiar Fluoroscopic shadows point guide that's going to help us accurately place our femoral point for the mpfl reconstruction. We have a graph prep board and sizer. And finally we have two fiber loops that come on the 0.9mm tape. Here we have a right knee for our Mpfl onlay reconstruction. So we made a medial incision to the patella. We made it just a little bit longer for visualization. Really wanted to show this technique this online technique. So here we've found our retinacular layer between layers two and three. So we're just going to come down one level onto the medial aspect of the patella. And one thing that's very important with our onlay is we really need a good bone prep. So you can see here where extra articular. Here's the top of the patella. We're down to the 50 yard line. But we have a nice bone prep here. And we really want to encourage that surface healing for the onlay technique. So a couple pearls to be able to place these knotless fiber tacks on the mobile patella. So one is we place the knee into some flexion, which gives some more inherent stability of the patella and the groove. And really the game changer here is our knee fiber tack ratcheting guide. So our ratcheting guide can help us completely keep the patella stable. So you don't need to rely on a lot of back pressure or an assistant while you're doing your drilling. So you can see the spiked edge goes here on the lateral side. And then this ratchets down on the medial side. So we'll place that superior anchor first. So I'm just feeling the lateral side of the patella. And then we're going to ratchet down for our superior anchor. And we can really get some great stability. You can see we have nice and total control of that patella. So then we're going to take our 2.8mm hard bone drill. And I'm doing this without an assistant. So this male has really hard bone. So we're going to make sure that we cycle a few times. And then once we have our knotless fiber tech hybrid anchor, this is non-self punching. So we can just get it started and then just give it a few gentle taps to seat it. So you can really see how our guide stabilizes the whole entire system here for us. So once the anchor is seated then we can unravel our sutures. And again this is the hybrid option. So we have our needles here and we have our blue knotless suture that's already pre converted for us and our little white suture to maintain our loop. So now we can take our guide away. And there's a little slot on the side where the sutures can come out easily. And then we just want to make sure we have really good fixation. You can see we've got complete control of that patella. So now we're just going to separate out our sutures. So we have our two black sutures and they come pre-loaded with needles. So we're going to use this to actually help us reconstruct the nwcfl portion. So we'll put those on the side. And then here you can see the pre converted loop that's ready to go. You can check to see if it slides a little bit. But we want to put our graft directly through this loop. So we're going to come in here and place our second anchor. This one's going to be more distal at about our 50 yard line. So here I'm just really ratcheting again have really good one handed control of that patella. And then we'll come in here with our 2.8mm drill bit. It's really hard bone here. We'll just cycle a couple of times. And these are non punching inserter. So we'll just get it started. And then we'll be able to tap the anchor down fully seated. So that's positive. Stop. So then we'll take off our sutures and be ready to go with our second anchor. So now both hybrid anchors are fully ready to go on the patella. You can see we have our two knotless loops here which we'll put our graph directly through. And then we have our two sets of needles here that we're going to show you how we incorporate these into the reconstruction as well. So now we're ready to pass our graft on the patellar side. So this step is quite easy because we don't have to do really a lot of graft prep. On the back table here. All we did is we placed a mark directly in the center of the graph. So we have our graph center point measured. And we're right between our two knotless loops. We are going to perform an MQ TfL portion of this reconstruction. So what we'll do is we'll take the center point. And we're just going to shift it proximally right into that first loop. And that's going to give us a little extra graft to do our MQ TfL portion of the reconstruction. So once this is set up now we can use our Knotless portion. And we're just going to bring these down one at a time. And again we're trying to line this one up with the Blues. So we'll just set provisional tension. And you can see how this really gets amazing fixation of your graft. So we have that tissue compressed right to bleeding bone. And our fixation on the patella is fantastic. You can see we have complete control here. So we have our two anchors secured on the patella. Right here is the superior aspect of patella. And here's the quad tendon. So what we're going to use is a portion of the hybrid anchor. Now to actually perform part of the reconstruction. So we're going to really recreate the quadriceps portion of our stability. So here we're taking the preloaded needle. We're going through our graft. And here you can see our quad tendon. So we're going to actually dock this right on the undersurface of our quad tendon. And it's as simple as that. And now we're just going to tie a knot for fixation. So once we have the graft fixed here you can see we have fixation above the patella into our quadriceps about a centimeter to 15mm. And that's why we need a little excess graft above. But now our fixation is complete on the patellar side. So now we're sewing both limbs of the graft together. And this is our 0.9mm suture tape. So it's very important that we have both limbs of the graft on equal tension here and clamped. What's nice about this technique is we don't have to worry as much about length as when we're creating a socket. Technique. The onlay technique is a little bit more versatile and flexible that way. So once our patellar fixation is complete and the graft is ready, we'll work on our femoral side. And again this is onlay fixation on the femoral side. We don't want to neglect the most important part of the operation which is getting the anatomy correct. So I still like to use shuttles Fluoroscopic guide. And we have a 2.4mm guide pin just like any other variation of the technique. So we want to make sure that this is lined up really well on x ray. X-ray and we also confirm isometrically with our pin. So once we have our pin placed radiographically, then we want to make sure we're okay from an isometric standpoint. So we're going to pass our clamp here extra Articularly. We have our fiber snare shuttle that we're going to use to shuttle the graft between the layers. So now our sutures are loaded in the fiber snare. So I'm just going to lift up this layer. And then we're going to shuttle our sutures. First they're going to come out our femoral incision. And then our graft is going to follow. So you can see our graph length looks good. Now we're going to check our isometry. So here we're in about 90 degrees of flexion. But we really want this graft isometric from 0 to 90. So I'm going to place my finger on the graft and the pin and make sure that this is isometric through a 90 degree range of motion. And typically the mistake is to place the pin and the point a little bit too anterior or proximal. But this one feels very good. So we're happy with both our radiographic landmarks anatomic landmarks and our isometry. So once we've confirmed our 2.4mm pin placement, now it's time to place our anchor. One of the other aspects of this ratcheting guide is that this guide will completely detach. And then we can slide this right over our 2.4mm guide pin. And this helps protect it. Now if you have really hard bone you could remove this pin and go back to your 2.8mm drill. But in most cases we're able to just remove our two four pin and then place our anchor in that same pilot hole, so we'll tap this in to a positive stop. So again we're we're hybrid anchor on the femoral side as well. So we have both our knotless loop for our graft fixation but also an extra pair extra set of needles to help us with additional fixation. So we're going to set that anchor make sure we have great fixation. And now we're ready for graft fixation. So we're ready to go for graft passage on the femoral side and fixation. It's very important to remember we really want to do a good biologic preparation. So typically I'm really taking a curette here and just kind of really scraping that periosteal bone. Again one of the key elements we need with our onlay fixation. So then we can pass our, our graft sutures through the loop. So we'll typically pass our sutures first. And then we'll make sure this graph is lined up. Now the tension of the graph obviously one of the most important aspects of Mpfl reconstruction. So you can notice our knee here is in 30 degrees of flexion. So our patella is starting to engage in the groove. And then we don't want to over tension. So you don't have to put a lot of tension on this graft. But we'll first tension the loop down and. We'll bring that right down. And that that sucks down the graft really nicely. You can see the fixation that you get there on the surface with our Onlay technique and our knotless fiber tack portion. So now we can use the other portion of our hybrid fiber tack. And we're just going to get some fixation of the graft proximally towards your patella side. So here on the anterior portion we'll just place a simple suture. And then in the posterior portion, we can place a mattress suture through the graft. When we looked at the biomechanics of this construct, this was very much equivalent to a socket type of fixation. So again, a lot of advantages for maintaining bone real estate with this onlay technique. And you get one more point of fixation. With the knotted suture limbs. So if you want at this point you can retension your knotless portion. But everything here is very secure. So we'll just trim our sutures. And then this excess graft at this point you can trim as well. And that's one of the nice aspects of the Onlay technique. The graft length does not matter as much once we have our surface fixation. So once our graft is trimmed, you can see the broad footprint of fixation that we have here against our prepared bleeding bone. So a true onlay technique both on the patella as well as on the femur. Okay. So at this point we've got everything secure on the patella as well as the femur. So we're just going to use the remaining sutures to repair our retinaculum. So these two tensioning limbs at this point we can trim. And then we still have our double loaded needles from our hybrid anchor previously. So we're going to use these to help repair this retinaculum. Sometimes there can be a retinacular injury as part of this constellation of instability. But these do a really nice job of just closing Everything up and securing it to your patellar side. So I typically just place two simple sutures, one on each side of the retinaculum. So at this point our sutures are set and we can complete this retinacular repair. We can also perform imbrication if needed. But at this point our graft is set and we'll trim these. And you can see our final repair on the patellar side. Again we have our fixation not only on the patella but also in the quad tendon as well. So overall very nice online procedure.

Rekonstruktion des Lig. patellofemorale mediale

All-Onlay MPFL Reconstruction

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