medial Patello femoral ligament (MPFL) Reconstruction
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This document describes the case of a 35-year-old male construction worker who presented with recurrent patellar dislocations. An MRI revealed a medial patellofemoral ligament (MPFL) tear. The diagnosis was chronic patellar instability due to an MPFL tear. The treatment plan was for an arthroscopically assisted MPFL reconstruction using an autograft hamstring tendon. Post-operative rehabilitation started with the knee immobilized in extension to avoid flexion and allow early walking.
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medial Patello femoral ligament (MPFL) Reconstruction
- 1. ORTHOPEDIC SURGERY UNIT 1 DR.M IMRAN ASHRAF PGR ORTHOPEDIC SURGERY
- 2. 35 YRS OLD MALE RESIDENT OF KANGAN PUR, MARRIED, CONSTRUCTION WORKER BY PROFESSION PRESENTED WITH COMPLAINTS OF RECURRENT PATELLAR DISLOCATIONS 5-6 EPISODES
- 3. PAST SURGICAL HISTORY –VE PAST MEDICAL HISTORY –VE FAMILY HISTORY NOT SIGNIFICANT DRUGS HISTORY:NOT SIGNIFICANT Personal history: lives in his own house with family on ground floor with good sunlight and ventilation .belongs to lower socioeconomic status
- 4. G.P.E WAS UNREMARAKBLE SYSTEMIC EXAMINATION WAS UNREMARKABLE BEIGHTON SCORE WAS NORMAL
- 5. QUADRICEPS ATROPHY APPREHENSION TEST +VE J SIGN -VE GAIT WAS ANTALGIC WITH SHORT STANCE PHASE WITH NO SWAYING OF UPPER TRUNK
- 6. ON AP VIEW : NORMAL ANATOMICAL ALIGNMENT OF FEMUR AND TIBIA NO VARUS AND VALGUS DEFORMITY CORTICAL BREACH OF PATTELLA (ARROW)
- 7. on Lateral view Trochlear dysplasia -ve cross over sign -ve no supratrochlear spur -ve Normal patellar height INSALL SALVATI RATIO WAS 1 (NORMAL VALUE IS 0.8- 1.2) PATELLAR HEIGHT PATTELAR TENDON LENGTH
- 9. SUNSET VIEW RADIOGRAPH SULCUS ANGLE IS 130 DEGREE NO FEMORAL CONDYLE HYPOPLASIA BARPATITE PATELLA LATERAL PATELLA FEMORAL ANGLE IS NORMAL I.E. >11 DEGREE BIPARTITE PATTELA
- 12. AXIAL VIEW MRI POSITIVE FINDINGS WERE BIPARTITE PATTELA MPFL TEAR NORMAL SULCUS DEPTH 3mm BIPARTITE PATELLA DEPTH OF SULCUS >3mm MPFL TEAR
- 13. CORONAL VIEW OF MRI MPFL TEAR
- 14. DIAGNOSIS IS ?
- 15. CHRONIC PATTELAR INSTABILITY DUE TO MEDIAL PATTELO FEMORAL LIGAMENT TEAR SUGGESTED BY RECURRENT PATTELAR DISLOCATION MPFL TEAR ON MRI NORMAL SULCUS DEPTH
- 17. PATELLA The patella (derived from Latin means 'small plate') is a flat, inverted triangular bone, situated on the front of the knee-joint. It is the largest sesamoid bone, developed in the tendon of the Quadriceps femoris
- 18. Passive stability: MPFL first 20-30 degrees of knee flexion. trochlear groove morphology patella height patellar tracking Dynamic stability: vastus medialis (vmo)
- 19. TREATMENT OPTIONS OPEN RECONSTRUCTION ARTHROSCOPIC ASSISSTED RECONTRUCTION
- 21. PLAN ARTHROSCOPICALLY ASSISTED MPFL RECONSTRUCTION WITH AUTOLOGOUS HAMSTRING GRAFT.
- 24. IMMEDIATE POST OPERATIVE REHABILITATION PROTOCOL WAS STARTED WITH KNEE IMMOBILZER IN PLACE IN EXTENSION TO AVOID FLEXION AND PATIENT CAN START WALKING WITH THE HELP OF WALKER
- 25. TAKE HOME MESSAGE CONVENTIONAL METHOD OPEN TECHNIQUE LARGE INCINSION DELAYED WEIGHT BEARING BIG SCAR OVER KNEE MORE WOUND RELATED COMPLICATIONS VS • LATEST TECHNIQUE • ARTHROSCOPIC ASSISSTED • SMALL INCISION • EARLY WEIGHT BEARING • LESS WOUND COMPLICATION
Editor's Notes
- 35
- Q ANGLE
- ON