MPFL reconstruction using a quadriceps tendon graft: part 2: operative technique and short term clinical results.

BACKGROUND

We describe the preliminary clinical results of a new operative technique for MPFL reconstruction using a strip of quadriceps tendon (QT).

PATIENTS

17 patients (7 male, 10 female; mean age 21.5 years ± 3.9) have been operated on with this technique. All patients were evaluated clinically, radiologically and with subjective questionnaires (Tegner-, Lysholm-, Kujala Score) pre-operatively and post-operatively at 6 and 12 months (m).

SURGICAL TECHNIQUE

A 10 to 12 mm wide, 3mm thick and 8 to 10 cm long strip from the central aspect of quadriceps tendon is harvested subcutaneously. The tendon strip is then dissected distally on the patella, left attached, diverged 90° medially underneath the medial prepatellar tissue and fixed with 2 sutures. The graft is fixed in 20° of knee flexion with a bioabsorbable interference screw.

RESULTS

Lysholm score at 6m was 81.9 ± 11.7 and at 12 m 88.1 ± 10.9, Kujala score at 12 m was 89.2 ± 7.1 and Tegner Score was 4.9 ± 2.0 (6m) and 5.0 ± 1.9 (12 m). Two patients had a positive apprehension test at 12 months. There was no re-dislocation during the follow-up period.

CONCLUSION

MPFL reconstruction with a strip of QT harvested in a minimal invasive technique was found to be associated with good short term clinical results. We think that this technique presents a valuable alternative to common hamstring techniques for primary MPFL reconstruction in children and adults, as well as for MPFL revision surgery.

LEVEL OF EVIDENCE

IV, prospective case series.