engleski

Plantaris tendon autograft for the anatomic reconstruction of the medial patellofemoral ligament

Introduction Medial patellofemoral ligament (MPFL) reconstruction is a standard treatment option for selected patients suffering from patellar instability. Although frequently performed, the optimal surgical approach and graft source for the procedure have not been established. Autografts taken around the knee, more specifically hamstrings and quadriceps tendons, have emerged as a preferred choice. However, some reports on harvesting of these autografts describe more or less impact on the residual knee biomechanics. In contrary, harvesting a plantaris tendon has minimal influence on knee biomechanics. Aim The aim of this study is to point out that plantaris tendon autograft could be sufficient to replace the native MPFL in its reconstruction, and therefore restore patellar stability. Surgical technique A diagnostic arthroscopy was done to exclude any intraarticular pathology. Plantaris tendon was harvested using a proximal approach with a closed tendon striper through a small vertical skin incision 1 cm posterior to the medial border of the tibia at the junction of the proximal and the middle third of the lower leg. A 34 cm long plantaris tendon was obtained and folded in half. For the patellar insertion of the MPFL substitute, two 25 mm holes were created with a 4.5 mm guidewire-assisted drill inside the groove (sulcus) in the proximal third of the medial patellar margin. To fix both ends of the double-looped plantaris tendon autograft inside the holes, a 4.75 mm BioComposite SwiveLock anchor (Arthrex) was used. The anatomic femoral insertion point of the MPFL was identified, according to Schöttle et al., with lateral view images obtained with the fluoroscopy. The femoral tunnel was drilled with a cannulated 6.5 mm drill. Plantaris tendon autograft was then shuttled between the second and the third layer of the original MPFL. Using a 6 mm BioComposite Interference Screw (Arthrex), the graft was fixed inside the femur at 30° of knee flexion. Conclusions Our limited results showed that four-folded plantaris tendon autograft used for adolescent isolated anatomic MPFL reconstruction restored patellar stability. When using plantaris tendon autograft for native MPFL substitute, other possible autograft sources with greater functional relevance in knee biomechanics are preserved. However, further clinical studies are needed to validate the broad applicability of this approach and to document its long-term outcome superiority over currently used strategies.

Plnataris tendon ; MPFL reconstruction

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