Patellar graft fixation during medial patellofemoral ligament reconstruction using hybrid 2-point fixation technique of senior author. The step-by-step process for the open portion of the procedure is outlined. After visualization of the joint space arthroscopically, a 3- to 4-cm longitudinal incision is made over the superior border of the patella, and dissection is performed past layers 1 and 2. By use of a 2.4-mm drill bit, the proximal anchor is placed at the superior one-third of the proximal patella. The drill bit is used to create a blind tunnel, and a 3.0-mm suture is then drilled into the blind tunnel until it is fully seated. Biplanar intraoperative fluoroscopy is used to confirm the anchor position with the bone and assess the height of the anchor. On the basis of the position of the first anchor, the second anchor can then be placed appropriately to re-create the anatomy. This process is repeated for placement of the distal anchor, which is about 0.75 cm distal to the proximal anchor. During placement of the proximal and distal suture anchors, counterpressure is placed on the lateral border of the patella for increased stability. Once the suture anchors on the patella are placed, the semitendinosus allograft is sutured onto the medial border of the patella to create a “parachute.” The graft is then transferred between layers 2 and 3 of the medial knee toward the distal femoral insertion site. Under fluoroscopic guidance, the Schöttle point is determined for graft placement at the femoral attachment site. An interference screw is then placed within the reamed tunnel while the knee is positioned at between 30° and 45° of flexion.
- McNeilan R.J.
- Everhart J.S.
- Mescher P.K.
- Abouljoud M.
- Magnussen R.A.
- Flanigan D.C.
History and Physical Examination
Surgical Setup and Preoperative Examination
- Migliorini F.
- Driessen A.
- Quack V.
- Schenker H.
- Tingart M.
- Eschweiler J.
|The use of transpatellar bone tunnels is avoided.|
|The risk of fracture to the patella is decreased.|
|The graft-to-bone contact surface area is increased.|
|The native stabilizing forces on the patella are re-created.|
|The graft construct is biomechanically weaker compared with the use of transpatellar bone tunnels.|
|The MQTFL is not re-created.|
|A true lateral view of the knee is required to determine the Schöttle point for femoral graft placement.|
|Counterpressure should be placed on the lateral border of the patella during suture anchor placement for increased stability and control.|
|When integrating the free ends of the graft together, one should use 5-7 passes of the FiberLoop.|
|The femoral interference screw should be fixed at 30° to 45° of knee flexion.|
| Over-tensioning the graft can lead to increased medial contact pressure and patellar tilting.|
|Delayed advancement of weight-bearing activities can result in prolonged knee stiffness.|
- ICMJE author disclosure forms
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The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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