Post on 21-Jan-2018
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MPFL Reconstruction for Patellar Instability
Dr SHEKHAR SRIVASTAV Sr.Consultant- Arthroscopy
(Knee & Shoulder) Sant Parmanand Hospital,Delhi
Patellar Instability Incidence Primary Patellar Dislocation- 5.8 / 10000 Recurrence rate – 15 – 44% > 100 surgeries-
-Lateral retinacular release, -Proximal realignment, -Distal realignment, -Trochleoplasty -Combinations
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)
Case 1 15 yr old girl Recurrent Instability following trauma Apprehension test- +ve
Surgical Technique - Diagnostic Arthroscopy - Look for any Osteochondral fragment (Loose body) - Look for any Chondral damage - Patellar tracking though Supero-lateral portal
Graft Harvest
Gracilis/ Semi-T Graft – Harvest
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
Patella fixation
Patella Fixation
Graft fixed in Patella with Anchors
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
Femoral Tunnels
Leg
Thigh
Medial
Lateral Wire directed anteriorly and Proximally
Femoral Tunnel
Graft Passage
Graft passed to the medial wound through Tunnel Sub-muscular but Extra Synovial
Graft Passage
Graft Fixation
Fixed in the femoral tunnel at an angle of 30-450 degree and patella centered in trochlear groove Avoid overtightening
Radiographs
Clinical Pictures
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
THANK YOU
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