Lateral PatelloFemoral Ligament Reconstruction for Instability
There is little previous description of successful reconstruction of the lateral side to increase patellar stability and decrease Lateral Patellar Laxity (LPL). The previous reports describe direct repair of a previous lateral release or local reinforcement of the lateral tissues to be done for medial patellar dislocation. There is one prior report of using a tendon graft from the quadriceps tendon with a patellar bone fragment. Few long term results are available and the reports are of small number of cases.
I have found that direct repair of a previous lateral release is possible and will temporarily improve stability. However, my experience over 25 years shows that these repairs stretch and instability reoccurs. There has not been a dependable answer for this problem until the past few years. I have developed a new technique for stabilizing the lateral side of the patella using a tendon graft from the quadriceps tendon to reconstruct the Lateral PatelloFemoral Ligament (LPFL). It has been extremely successful and the patients have not had recurrence of instability.
The lateral patellofemoral ligament (LPFL) runs from the superior lateral patella to the lateral femoral epicondyle, a bony prominence. It is a described ligament but does not have a well defined structure. To prepare the tendon graft, part of the quadriceps tendon above the patella is separated leaving it attached to the patella. This tendon is then anchored to the lateral femur. This stabilizes the lateral side of the patella and does not restrict motion.
This can be done as an isolated procedure or can be combined with tibial tubercle transfer or medial patellofemoral ligament reconstruction in revision of failed prior surgery. It can also be done to add stability to a patellofemoral joint replacement or even for patellar instability following total knee replacement.
This is a simple procedure that can be done as an outpatient. It has a rapid recovery and has been extremely successful at eliminating LPL. It has held up well and does not appear to stretch. This the most effective procedure I have found to control this instability. A scientific paper has been published describing this new procedure.
Lateral patellofemoral ligament reconstruction using a quadriceps tendon graft. Saper M, Shneider D: Arthroscopy Techniques 2014;3(4):e445-8.
There is little previous description of successful reconstruction of the lateral side to increase patellar stability and decrease Lateral Patellar Laxity (LPL). The previous reports describe direct repair of a previous lateral release or local reinforcement of the lateral tissues to be done for medial patellar dislocation. There is one prior report of using a tendon graft from the quadriceps tendon with a patellar bone fragment. Few long term results are available and the reports are of small number of cases.
I have found that direct repair of a previous lateral release is possible and will temporarily improve stability. However, my experience over 25 years shows that these repairs stretch and instability reoccurs. There has not been a dependable answer for this problem until the past few years. I have developed a new technique for stabilizing the lateral side of the patella using a tendon graft from the quadriceps tendon to reconstruct the Lateral PatelloFemoral Ligament (LPFL). It has been extremely successful and the patients have not had recurrence of instability.
The lateral patellofemoral ligament (LPFL) runs from the superior lateral patella to the lateral femoral epicondyle, a bony prominence. It is a described ligament but does not have a well defined structure. To prepare the tendon graft, part of the quadriceps tendon above the patella is separated leaving it attached to the patella. This tendon is then anchored to the lateral femur. This stabilizes the lateral side of the patella and does not restrict motion.
This can be done as an isolated procedure or can be combined with tibial tubercle transfer or medial patellofemoral ligament reconstruction in revision of failed prior surgery. It can also be done to add stability to a patellofemoral joint replacement or even for patellar instability following total knee replacement.
This is a simple procedure that can be done as an outpatient. It has a rapid recovery and has been extremely successful at eliminating LPL. It has held up well and does not appear to stretch. This the most effective procedure I have found to control this instability. A scientific paper has been published describing this new procedure.
Lateral patellofemoral ligament reconstruction using a quadriceps tendon graft. Saper M, Shneider D: Arthroscopy Techniques 2014;3(4):e445-8.
