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Anatomic Double-bundle Medial Patellofemoral Ligament Reconstruction With Aperture Fixation Using an Adjustable-length Loop Device

March 01, 2020

Contributors: Hyuk Min Kwon; Jihyeon Park; Jaeang Sim, MPH; Byung Hoon Lee, MD

Introduction This video aims to assess the clinical viability of an adjustable-length loop device for aperture fixation at the patella and femur during anatomic double-bundle medial patellofemoral ligament reconstruction for the management of recurrent patellar dislocation. Methods We retrospectively reviewed 11 patients (12 knees) with recurrent patellar dislocation who underwent anatomic double-bundle medial patellofemoral ligament reconstruction with the use of an ipsilateral semitendinosus tendon autograft. The graft was folded in half, and its central portion was hanged with the use of an adjustable-length loop device. Both free ends of the graft were fixed at the proximal and distal ends of the medial edge of the patella with the use of suture anchors, and the hanged graft loop was pulled into the femoral tunnel while maintaining equal tension on both bundles. Manual traction was applied to the suture loops to appropriately fix the graft in full knee range of motion under arthroscopic guidance. Clinical outcomes, such as the rate of re-dislocation, range of motion, clinical scores (Kujala score, Lysholm Knee Scale score, and visual analog scale score for anterior knee pain), and complications, were assessed preoperatively and 2 years postoperatively. Radiographic parameters indicating patellar position, including congruence angle and lateral patellofemoral angle, were measured at four different angles of knee flexion (30°, 45°, 60°, and 90°). Results At four different angles of knee flexion, the preoperative congruence angle decreased significantly and the lateral patellofemoral angle increased significantly at final follow-up (P < 0.001). Notably, improvements in these angles were maintained with no significant differences at the four different angles of knee flexion. None of the patients experienced subluxation or re-dislocation postoperatively. Patellar instability symptoms improved based on radiographic and other clinical outcomes. Conclusion Double-bundle medial patellofemoral ligament reconstruction with aperture fixation at the patella and femur using an adjustable-length loop device affords high stability with full knee range of motion and may be considered a feasible technique for the management of recurrent patellar dislocation.