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Arthroscopy assisted mpfl reconstruction
This document describes the surgical procedure of arthroscopy assisted MPFL reconstruction. It begins with an overview of the MPFL ligament and indications for reconstruction. The summary is as follows: 1. MPFL reconstruction is used to treat recurrent lateral patellar dislocation through anatomical repair of the medial patellofemoral ligament. 2. The procedure involves graft harvesting, preparation of the patella and femur tunnels, passing the graft and securing it under arthroscopic visualization. 3. Post-operatively, patients follow a protocol of restricted motion and weight bearing to allow healing, with results showing full recovery of function and no further dislocations.
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Arthroscopy assisted mpfl reconstruction
- 1. ARTHROSCOPY ASSISTED MPFL RECONSTRUCTION DR.SABYASACHIBARDHAN DR.S KUMAR DR.A.K.GARG DR.K.K.MUKHOPADHYAY
- 2. MPFL •Most important static restraint •Extrasynovial ligament •Medialfemoral epicondyle to medial patellar edge ; 6-7cm,deep to the distal part of vastas medialis obliqus.
- 3. MPFL RECONSTRUCTION • Proximal realignmentfor patellar instability • Classical indication of isolated MPFL reconstruction is post traumatic lateral patellar dislocation having no anterior knee pain. • Anatomical repair ; Open or arthroscopic
- 4. CLINICAL PROFILE • H/Odislocation of patella…single or multiple episodes • Patellar translation • Patellar tilt test • Apprehension test • Retropatellar tenderness • Knee ROM & patellar tracking • Q angle
- 5. IMAGING • Standard Xray of knee -AP, Lateral & skyline view • MRI
- 6. CHOICE OF PATIENTS INDICATIONS •Young • Recurrent dislocation • Painless CONTRAINDICATIONS • Tight lateral structures • Medial instability • Q angle>20 degs/ genu valgum are relative contraindications for isolated MPFL reconstruction
- 7. OVERVIEW OF STEPS • • • • • • • Examinationunder anaesthesia Diagnostic scopy Graft harvest Patellar preparation Femoral condyle preparation Graft passage and graft isometry check Fixation under arthroscopic supervision.
- 8. EXAMINATION UNDER ANAESTHESIA •Patellar stability, translation, and tilt are usually easier to characterize when the patient is anesthetized • If the patient's symptoms and exam are consistent with excessive lateral retinacular tightness, then consideration should be given to performing a concomitant arthroscopic lateral retinacular release.
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- 11. DIAGNOSTIC ARTHROSCOPY • Carefulassesment of loose bodies • Articular surfaces , patella and trochlear surface are carefully examined • Patellar tracking
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- 13. GRAFT HARVEST • Semitendinousgraft • Standard harvesting technique
- 14. PATELLAR TUNNEL •Make two tunnelsof 10mm each the first one just where the obliquity of medial border turns to be straight. •The other one 10mm below that •Each tunnel is about 4mm in diameter •Tunnels are made in divergent fashion
- 15. PATELLAR TUNNEL •Vertical drill holesof the same diameter are made 1 cm from the medial patellar margin in a antero post fashion to connect with the horizontal tunnels. •Once tunnel is made Each end of the graft is passed through .
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- 17. FEMORAL PREPARATION •Femoral attachment site ofthe MPFL is in between medial epicondyle and adductor tubercle •Malposition of the femoral tunnel even 5 mm results in increased graft force . •3cms incision over the medial epicondyl. Adductor tubercle identified. A beath pin is drilled across to the opposite cortex
- 18. Between the patellarand femoral incision a dialator is passed to make room for the passage of the graft between the layer 2 and 3.
- 19. GRAFT ISOMETRY • Tocheck the behavior of the graft through a range of motion. • Done by passing a beath pin through the femoral attachment site and wrapping the graft around it observing the length change behavior of the graft between 30-90 range • Fixed to femur with Intf screw
- 20. FINAL TENSIONING OFGRAFT AND FIXATION • Most important step dictating the surgical outcome • Prime importance to avoid graft over tightening. • Arthroscopic visualisation of patellar tracking confirms that patella is fitting properly in the grove without excessive medial pull.
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- 22. POST OP PROTOCOL •Static quadriceps after 24 hrs • Dressing change with lighter dressing after 48hrs. • Knee bending, Heel slides to start after 48 hrs; knee brace at all other times, to attain 90 degs flexion by 2 wks • Partial weight bearing after 48hrs….full weight bearing by 6 weeks
- 23. RESULTS • No ofpatients : 6 (4 females, 2 males) • 16y-37y • One of them is professional dancer and one elite athlete. • The cause of dislocation was post trauma in all cases. • None of them had preceding anterior knee pain. • Average follow up period was 11 months
- 24. RESULTS ROM: • All patientshad 90 deg flexion by 3 weeks. and no extension lag by 6weeks. • All patients had no pain and full range of movement by 6 weeks.
- 25. RESULTS • All ofthem achieved their pre injury activity level and did not have any apprehension or episode of dislocation during the follow up period. • One patient had a minor skin infection immediate post op which resolved with antibiotics.
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- 27. CONCLUSION MPFL reconstruction isa relatively safe technique with very predictable outcome in carefully selected subset of patients with recurrent patellar lateral instability.
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