Name: MPFL Reconstruction Using the Onlay MPFL Implant System With the FastThread™ Interference Screw
Uploaded: 2025-12-30T00:00:00Z
Channel: Arthrex
Description: Daryl C. Osbahr, MD (Orlando, FL), reviews the contents and use of the Onlay MPFL Implant System with Knee FiberTak® anchors for patellar fixation and the FastThread™ interference screw for femoral fixation.

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Daryl C. Osbahr, MD (Orlando, FL), reviews the contents and use of the Onlay MPFL Implant System with Knee FiberTak® anchors for patellar fixation and the FastThread™ interference screw for femoral fixation.

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video

VID1-008120-en-US | A | MPFL Reconstruction Using the Onlay MPFL Implant System With the FastThread™ Interference Screw

Daryl C. Osbahr

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

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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MPFL Reconstruction Using the Onlay MPFL Implant System With the FastThread™ Interference Screw

Hi, I'm doctor Daryl Osbahr. I'm with Rothman Orthopedics of Florida at AdventHealth. Today we're going to be talking about the knee. Fiber tech only Mpfl kit with the fast thread screw. So I'm going to explain to you what's in the kit. We're going to use the hybrid knee fiber tech with the one knotless tensioned loop and sliding suture tape with needles. We also have a new and exciting patella ratcheting knee fiber tech guide, and we have the 2.8 hard bone drill you can see here on the table. We also have the sutures that we're going to be able to put through the graft. We have the disposable fast thread screwdriver. We also have the drill bit and we have the seven millimeter reamer. We have the guide wire. And then we also have the two fiber standards to be able to pass the graft. In addition we have the Mpfl template as well as the disposable graft board for graft sizing to give orientation. This is the medial side of the knee and the lateral side of the knee. So some of our landmarks this is the patella that I've outlined. This is the medial epicondyle that I've outlined. So this will give us our access to the patella side of our fixation in the femoral side of our fixation. I'm going to make the patella incision first at the medial aspect of the patella. To give orientation this is the medial side of the patella. We can see some of the mpfl tissue and retinacular tissue coming in. And we can see the vastus medialis obliquus coming in to enter the attachment site. For the medial side of the patella. There are several goals of what we can establish here. If we're considering doing a VMO advancement, we can make our medial parapatellar arthrotomy slightly extending up into the vastus medialis obliquus to be able to advance that medially. If not, we can do a standard peripatellar arthrotomy on the medial side. Here you can see I'm keeping the vastus medialis obliquus intact and not actually advancing it. In this case, once I have the medial side of the patella exposed, I will use a combination of a curette and a rongeur to prepare a good bony surface here, so our reconstruction can heal against this surface. Staying extra articular and along the mpfl. We can see this interval that we're able to develop to be able to get right down to the femoral side. Now I'm going to mark the superior medial border of the patella, as well as the midpoint on the medial aspect of the patella. These are our two fixation points for our knotless technology on the patella side. Now I'm going to show you the patella ratcheting guide. We can see the button right here which you can push down and allows you to telescope. So that way when we get this fixated to the patella, we have a better grasp to more effectively and easier drill our tunnels. I'm going to first start with the superior drill hole. You can see here drill ratcheting it down. I have great grasp of the patella. Now I'm going to drill before placing my anchor. The new technology on this plant allows us to actually push the implant in without sometimes even having to use the mallet, because it's so easy to deliver it. This black suture has the needles for which ability use this to pass through the structures later in the case to repair those in tension compared to our mpfl reconstruction. This is the tension loop which will be able to actually use this to fixate the patella graft to the medial aspect of the patella. When we're setting the tension on this and actually pulling back to set the implant within the bone. We want to make sure we just pull the black sutures to do so. So we don't tension down our loop. So now we're going to fixate our ratcheting patella glide into that distal location on the patella. And we're going to drill. In place our second anchor. So you can see how easy that was to be able to actually fixate the graft into the patella using the ratcheting guide. And this new knotless fiber tack again. Now we're going to set the distal fiber tack. And you can see how well this is fixating the bone. In fact when I pull has great fixation. Now you can see we're putting the guide to be able to find shadows Point for our approach to the femur. Now in terms of Incisional approach you can make one incision or you can try to make two smaller incisions. This incision is usually about two times the size that I make on the medial aspect of the patella, especially now that we have the patella ratcheting guide. And then I'll make a small two centimeter incision over here to try to stay more minimally invasive while passing the graft. But the goal of this guide, along with x rays, to be able to find our shadows point so we can make sure that our orientation for our tunnel is in the right position for an isometric graft placement, I'm going to now make my femoral approach incision. I want to be careful to stay right at the level of the skin. Always want to be careful about the medial saphenous. I will now take a Metz. Try to develop a plane down to the medial epicondyle. I will then use my finger to identify the medial epicondyle, which is right here. And that helps me make sure that I can localize shadows point. This is the point in time that I'll actually use this guide along with x ray. I usually will have the knee at about 90 degrees of flexion and identify the perfect approach for shadows Point as I place either my guide wire or my anchor, depending upon if I'm using Knotless technology or I'm actually using the screw. Now that I have my drill pin in the correct location at Shadows Point, I will now drill, making sure to aim in the appropriate orientation. At this point, I will often make sure that I have a good plane of tissue identified around my tunnel and my guide wire to make sure that I'm able to pass the graft easier. In the case. Now, I'm going to take the reamer and drill over the guide pin. As you can see, I sometimes cycle it to make sure that I've eased of graft insertion because I really try to make sure the graph fits nicely. Now I'm going to take my fiber snare. I'm going to pass this through. And I'm going to have my assistant pull. And this will enable me to pass the graft into the tunnel later in the case. Now you can see I have everything set up the patella side with our knotless hybrid fiber tacks. And I have our socket on the femoral side to place our intraosseus screw. We can see here we have a disposable graft board. And this allows us to put tension on the graft, but also to mark the center point of the graft. This will enable us to identify the right point to put between our patella fixation sites. In this case, we're using the 6.5mm slotted tunnel. And we can see the graft passes nice and easy, which is perfect for our seven millimeter hole within the femur that we drilled. At this point, I'm going to make sure that I have a passageway for my graft around the interval of the mpfl within the medial structures. I'm going to be able to pass my hemostat down, and then I'm going to pass a fiber snare, which will enable me to pass the graft. Now we're going to pass the graft through our two tension loops right here. Now we have the area we marked. That would be the center point of the graft, right in between our tension double loops for the fixation. We're now going to tension our superior loop, which is going to fixate our graft to meals side of the patella. And we're going to do the same thing with the distal loop. Now that we've tensioned our superior and inferior tension double loops, we now have great fixation of our graft to the medial side of the patella with our knotless knee hybrid fiber tack. Now we're going to pass the graft limbs through the fiber snare, where we're going to pass this down through the layers on the medial side of the patella. This enables us to pass the graft to the femoral location that we're going to fixate. So now we can see we have the graft fixated to the medial side of the patella. Our graph limbs are entering the medial structures within the plane of the NPFL and going down toward the femoral side. We can also, later in the case, use this graph limb to fixate to the VMO, which is right here. So now we can see we have the graft which is now been passed through the medial structures. We have the hole that we drilled with the socket and our suture coming out of it. We're going to be able to pass the graft into the hole for which we have great visualization. At this point in time, you can actually pass the guidewire and then pass the graft, or you can pass the graft and subsequently the guidewire to make sure that you get a good plane to place your screw. Now we're going to use this 90 degree snap as a pulley to be able to pull the graft into the tunnel by first passing the sutures. And then we're going to pass the graft. Now I can visually see that we have the graft going into the tunnel and the graft appears very tight. Now we can see both limbs of the graft successfully going into the tunnel with appropriate tension. Now we're going to pass the guidewire, and we're going to place it in the tunnel and pass it in, where then we feel the opposite cortex and we know we're in bone. This is now going to enable us to be able to pass the screw over the guidewire, to fixate the graft on the femoral side. You can also use the tightrope, as well as the knee knotless fiber tack, to be able to fixate the graft on the femoral side as well. In review. Now that we can see we have great fixation with our inlay technique to the medial side of the patella, with our graft going through the medial structures and entering the tunnel in the femur, we have our assistant being able to hold tension on the graft on this side. And we make sure that we have a good one. Plus stability of the kneecap. So we're not over tensioning. We have our knee at 30 degrees and making sure that both the medial and lateral side of the patella have good fixation in both the medial and lateral planes, with the good end point but not over tensioned. Now we're going to take our disposable tri lobe fast thread screwdriver with our screw loaded on top of it. We're going to pass this down to our tunnel to be able to successfully fixate our graft within the femoral tunnel. We want to make sure we have tension on the graft while placing this. We want to put a little bit of force as you initially get it into the tunnel, and then usually it passes very easy. We want to make sure that we're able to see it actually go into the tunnel and to get great cortical fixation, which we can see right now. At this point in time, I will usually use a mallet to just lightly back this off. And then pass the guide wire back out. So now we can see the graft going into the femoral tunnel. And this is the hole for the screw that has great intraosseous fixation. Now I'm going to use my black suture tapes to be able to pass these through the medial structures. If I have a high riding VMO, I'm going to make sure that I be able to get a good grasp of this tissue to be able to advance it. You can see here I'm going to pass it through. And I'm going to take every single limb and pass it through. So that way I can tension this to match the tension of my graft for the tension sutures. You can also use these for additional fixation with an empty needle to be able to pass it as well and tie it down. In this case we will just use our suture tapes. Now I'm going to tie these suture tapes to be able to get great fixation of my mpfl tissues to match the tension of my graft. At this point, I have tensioned my repair back to the patella using the suture tapes. Sometimes in a pants over vest fashion, I will also pass one of the limbs around this tissue to be able to further tension. If I feel like I need that to dial it in, and I can do that both proximally and distally. The knee knotless fiber tack technology has enabled me to do this surgery in such an easy and reproducible way. The patella ratcheting clamp has enabled me to pass the suture anchors within the patella in a much easier fashion, making the surgery so much more efficient. And with this, I can actually do it in a way that minimizes any bone loss to the medial side of the patella and inherently lowers fracture risk.

MPFL Reconstruction

MPFL Reconstruction Using the Onlay MPFL Implant System With the FastThread™ Interference Screw

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