Joan LEAL-BLANQUET, Eduard ALENTORN-GELI, Raúl TORRES-CLARAMUNT, Joan Carles MONLLAU

Partial quadriceps tendon transfer for revision medial patellofemoral ligament reconstruction: A new surgical technique

Medial patellofemoral ligament (MPFL) reconstruction for patellofemoral instability is a common procedure. Although MPFL reconstruction is a successful procedure in terms of return to normal life orsports, revision cases are challenging due to previous holes into the patella or implants placed in theanatomical femoral insertion site. In this technical note, the use of a partial quadriceps tendon transfer tothe adductor magnus tendon is presented as a good solution for revision cases to avoid the use of implants, bone drilling, use of allografts, or two-stage surgical procedures. In addition, this procedure couldbe also used as a primary procedure in skeletally immature patients.

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1. Sillanpaa PJ, Maenpaa HM, Arendt EA. Treatment of lateral patella dislocation in the skeletally immature athlete. Oper Tech Sports Med. 2010;18(2):83e92.

2. Smith TO, Walker J, Russell N. Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2007;15(11):1301e1314.

3. Fink C, Veselko M, Herbort M, Hoser C. MPFL reconstruction using a quadriceps tendon graft: part 2: operative technique and short term clinical results. Knee. 2014;21(6):1175e1179.

4. Nelitz M, Williams SR. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft. Arthrosc Tech. 2014;3(2):e302ee308.

5. LeGrand AB, Greis PE, Dobbs RE, Burks RT. MPFL reconstruction. Sports Med Arthrosc. 2007;15(2):72e77.

6. Koh JL, Stewart C. Patellar instability. Clin Sports Med. 2014;33(3):461e476.

7. Avikainen VJ, Nikku RK, Seppanen-Lehmonen TK. Adductor magnus tenodesis for patellar dislocation. Technique and preliminary results. Clin Orthop Relat Res. 1993;297:12e16.

8. Sillanpaa P, Maenpaa HM, Mattila VM, Visuri T, Pihlajamaki H. A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note. Knee Surg Sports Traumatol Arthrosc. 2009;17(5):508e512.

9. Deie M, Ochi M, Sumen Y, Yasumoto M, Kobayashi K, Kimura H. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Jt Surg Br. 2003;85(6): 887e890.

10. Macura M, Veselko M. Simultaneous reconstruction of ruptured anterior cruciate ligament and medial patellofemoral ligament with ipsilateral quadriceps grafts. Arthroscopy. 2010;26(9):1258e1262.

11. Steensen RN, Dopirak RM, Maurus PB. A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft. Arthroscopy. 2005;21(3):365e370.

12. Russ SD, Tompkins M, Nuckley DJ, Macalena JA. Biomechanical comparison of patellar fixation techniques in medial patellofemoral ligament reconstruction. Am J Sports Med. 2015;43(1):195e199.

13. Herbort M, Hoser C, Domnick C, et al. MPFL reconstruction using a quadriceps tendon graft. Part 1: biomechanical properties of quadriceps tendon MPFL reconstruction in comparison to the intact MPFL. A human cadaveric study. Knee. 2014;21(6):1169e1174.

14. Herbort M, Hoser C, Lenschow S, et al. Biomechanical properties of a new MPFL reconstruction technique using quadriceps tendon in comparision to the intact MPFL. A human cadaveric study. Arthroscopy. 2013;29(10 Supplement):84e85.

15. Goyal D. Medial patellofemoral ligament reconstruction: the superficial quad technique. Am J Sports Med. 2013;41(5):1022e1029.