Qian Lily J, Schroeder Amanda J, Shea Kevin G, Cooper Trenton, Tompkins Marc
University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Glencoe Regional Health, Glencoe, Minnesota, USA.
Video J Sports Med. 2025 Jul 10;5(4):26350254241301444. doi: 10.1177/26350254241301444. eCollection 2025 Jul-Aug.
In skeletally immature patients, medial patellofemoral ligament (MPFL) reconstruction must consider the femoral physis while also trying to reproduce the ligament as anatomically as possible. There is currently no gold-standard surgical approach.
Previous surgical techniques for MPFL reconstruction in skeletally immature patients have described methods to avoid the physis, but it is difficult to accomplish this and still place the tunnel at Shottle's point. The technique described in this video allows the surgeon to find Shottle's point while still placing a tunnel that is all-epiphyseal.
Following MPFL attachment to the patella, the guide pin is placed at Schottle's point under fluoroscopic guidance, and the scope is placed facing the posterior cruciate ligament (PCL) footprint. With the knee at 90° of flexion or greater, the guide pin is passed through the femoral condyle, aiming directly at the scope such that the pin enters the notch through the PCL footprint. The pin can then be passed anteriorly through the knee and the anterolateral soft tissues without endangering the lateral femoral condyle or the patellar tendon. A blind-ended tunnel is then drilled through the epiphysis to the level of the cortex making up the PCL footprint. Care is taken to ensure appropriate graft length such that the graft does not "bottom out" in the tunnel. The graft is passed into the tunnel and secured with an interference screw while the knee is in 45° to 60° of flexion.
Expected outcomes for this all-epiphyseal MPFL reconstruction are very good. Patients begin physical therapy immediately after surgery and are allowed full weightbearing and full range of motion without a brace.
DISCUSSION/CONCLUSION: The MPFL attachment is very near the medial femoral physis. Due to the undulating physis, placing the start of the femoral tunnel at the femoral MPFL attachment point requires that the tunnel trajectory be directed toward the center of the knee. The technique described in this video allows for all-epiphyseal femoral tunnel drilling with a starting point at the MPFL femoral attachment, allowing the graft to be placed as anatomically as possible.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
在骨骼未成熟的患者中，髌股内侧韧带（MPFL）重建必须考虑股骨骨骺，同时尽可能在解剖学上重建韧带。目前尚无金标准的手术方法。
以往针对骨骼未成熟患者的MPFL重建手术技术描述了避免损伤骨骺的方法，但很难做到这一点同时又将隧道置于肖特尔点。本视频中描述的技术使外科医生能够找到肖特尔点，同时仍能放置一个全骨骺隧道。
在MPFL附着于髌骨后，在透视引导下将导针置于肖特尔点，将关节镜置于面向后交叉韧带（PCL）足迹的位置。膝关节屈曲90°或更大角度时，将导针穿过股骨髁，直接对准关节镜，使导针通过PCL足迹进入髁间窝。然后导针可向前穿过膝关节和前外侧软组织，而不会危及股骨外侧髁或髌腱。然后通过骨骺钻一个盲端隧道至构成PCL足迹的皮质水平。注意确保移植物长度合适，使移植物在隧道中不会“穿出”。在膝关节屈曲45°至60°时，将移植物置入隧道并用挤压螺钉固定。
这种全骨骺MPFL重建的预期效果非常好。患者术后立即开始物理治疗，无需支具即可完全负重和进行全范围活动。
讨论/结论：MPFL附着点非常靠近股骨内侧骨骺。由于骨骺呈波浪状，将股骨隧道起点置于股骨MPFL附着点需要使隧道轨迹朝向膝关节中心。本视频中描述的技术允许从MPFL股骨附着点开始进行全骨骺股骨隧道钻孔，使移植物尽可能按解剖位置放置。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本投稿发表包含患者发布声明或其他书面批准形式。
