MPFL Rec onstruction for Patellar Instability - By Dr Shekhar Srivastav . Surgical Technique - Diagnostic Arthroscopy - Look for any Osteochondral fragment (Loose body) - Look for any Chondral damage - Patellar tracking though Supero-lateral portal Post-op Protocol Ambulation with stick and Knee Brace- 3 wks ROM exer – Next day upto 300 and progress Review every 2 wks,6 wks,3 mnths,6 mnths and yearly thereafter Post-op assessment (Crosby-Insall criteria) Excellent- No pain,normal activity Good- Occasional pain,discomfort Fair/Poor- Pain,loss of flexion,recurrent dislocation/subluxation Worse- Pain increased,displacement more frequent Caution Must avoid overtightening- Medial instability Medial patellar arthritis Patellar fractures Preexisting Chondromalacia Details @ http://www.delhiarthroscopy.com/

1. MPFL Reconstruction for
Patellar Instability
Dr SHEKHAR SRIVASTAV
Sr.Consultant- Arthroscopy
(Knee & Shoulder)
Sant Parmanand Hospital,Delhi

2. Patellar Instability
Incidence Primary Patellar
Dislocation- 5.8 / 10000
Recurrence rate – 15 – 44%
> 100 surgeries-
-Lateral retinacular release,
-Proximal realignment,
-Distal realignment,
-Trochleoplasty
-Combinations

3. Patellar Stability
Three Imp. Factors
-Articular Geometry
-Muscle action
-Passive soft tissue restrain
Anatomic studies- MPFL contributes 60% of medial
restraining force (Desio et al AJSM 1998,conlan et al JBJS1993)
MPFL torn in 94% patients with acute patellar
dislocation (Sallay et al AJSM 1996)

4. Case 1
15 yr old girl
Recurrent Instability following trauma
Apprehension test- +ve

5. Surgical Technique
- Diagnostic Arthroscopy
- Look for any Osteochondral fragment
(Loose body)
- Look for any Chondral damage
- Patellar tracking though Supero-lateral portal

6. Graft Harvest
Gracilis/ Semi-T Graft – Harvest

7. Patella Fixation
Junction of Upper
1/3rd and lower 2/3rd
Should be at the
centre- not
violating ant.
Cortex or articular
surface.
Tunnel diameter-
Minimal to avoid
Patellar fracture

8. Patella fixation

9. Patella Fixation
Graft fixed in Patella with Anchors

10. Femoral
Tunnels
Schottle’s Insertion
Point-
2.5 mm distal to
Posterior cortical
line intersecting
with perpendicular
drawn from
posterior articular
surface of femoral
condyle

11. Femoral Tunnels
Leg
Thigh
Medial
Lateral
Wire directed anteriorly and Proximally

12. Femoral Tunnel

13. Graft Passage
Graft passed to the medial wound through Tunnel
Sub-muscular but Extra Synovial

14. Graft Passage

15. Graft Fixation
Fixed in the femoral
tunnel at an angle of
30-450 degree and
patella centered in
trochlear groove
Avoid overtightening

17. Radiographs

18. Clinical Pictures

19. Post-op Protocol
Ambulation with stick and Knee Brace- 3 wks
ROM exer – Next day upto 300 and progress
Review every 2 wks,6 wks,3 mnths,6 mnths and
yearly thereafter
Post-op assessment (Crosby-Insall criteria)
Excellent- No pain,normal activity
Good- Occasional pain,discomfort
Fair/Poor- Pain,loss of flexion,recurrent
dislocation/subluxation
Worse- Pain increased,displacement more
frequent

20. Caution
Must avoid overtightening-
Medial instability
Medial patellar arthritis
Patellar fractures
Preexisting Chondromalacia

21. THANK YOU
This presentation is available on
www.delhiarthroscopy.com