Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft

Background: Medial patellar instability is rare but may occur after lateral retinacular release. The lateral patellofemoral ligament is a significant stabilizer for medial and lateral patellar displacement, and soft tissue–based reconstruction may restore its stabilizing effect. Indications: Lateral...

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Autores principales:	Hailey P. Huddleston MD, Navya Dandu BS, Blake M. Bodendorfer MD, Adam B. Yanke MD, PhD
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Sports medicine RC1200-1245 Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/75200ff1301244b993c77fdb137cb36d
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spelling	oai:doaj.org-article:75200ff1301244b993c77fdb137cb36d2021-11-30T23:33:23ZLateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft2635-025410.1177/26350254211033608https://doaj.org/article/75200ff1301244b993c77fdb137cb36d2021-10-01T00:00:00Zhttps://doi.org/10.1177/26350254211033608https://doaj.org/toc/2635-0254Background: Medial patellar instability is rare but may occur after lateral retinacular release. The lateral patellofemoral ligament is a significant stabilizer for medial and lateral patellar displacement, and soft tissue–based reconstruction may restore its stabilizing effect. Indications: Lateral patellofemoral ligament reconstruction (LPFLR) is indicated for patellar instability failing exhaustive nonoperative measures. Technique Description: Diagnostic arthroscopy for medial patellofemoral ligament (MPFL) status, patellar tracking, chondral status, and postoperative changes of lateral retinacular release is conducted. A 5-cm incision is made between the midpoint of the patella and the lateral epicondyle, or a single midline incision can be used if performing a concomitant MPFL reconstruction. Dissection is carried down to the lateral retinaculum and capsule, and two 1-cm incisions are made at the distal and proximal patella through the patellar and quadriceps tendon, respectively. The lateral epicondyle is then directly palpated, and two 1-cm incisions are made directly anterior and posterior to the epicondyle into the iliotibial band in full extension. A hamstring allograft is then shuttled in a V-shaped configuration from the quadriceps tendon through the iliotibial band and finally to the patellar tendon. Excess graft is trimmed and doubled over proximally and distally to replicate the normal (or contralateral) 0° to 15° of patellar eversion. Trial resting length and tension is set with temporary sutures through the proximal and distal doubled graft in full extension. The knee is taken through full range of motion to ensure there is no graft tightening in flexion or loosening in full extension. Eversion and patellar translation are then examined. Heavy nonabsorbable sutures are used to set length of the doubled allograft proximally and distally. Results: Case series of LPFLR have demonstrated significant improvements in patients’ pain, Lysholm score and Knee Injury and Osteoarthritis Outcome Score, and kinesiophobia with no instability events and normal range of motion at short-term follow-up. Discussion/Conclusion: Medial patellar instability can occur following lateral retinacular release and patients experiencing instability despite nonoperative treatment are likely to benefit from a soft tissue–based LPFLR. Although other nongraft-based techniques may confer similar outcomes, the authors find it more reliable to perform a lateral reconstruction as described.Hailey P. Huddleston MDNavya Dandu BSBlake M. Bodendorfer MDAdam B. Yanke MD, PhDSAGE PublishingarticleSports medicineRC1200-1245Orthopedic surgeryRD701-811ENVideo Journal of Sports Medicine, Vol 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Sports medicine RC1200-1245 Orthopedic surgery RD701-811
spellingShingle	Sports medicine RC1200-1245 Orthopedic surgery RD701-811 Hailey P. Huddleston MD Navya Dandu BS Blake M. Bodendorfer MD Adam B. Yanke MD, PhD Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft
description	Background: Medial patellar instability is rare but may occur after lateral retinacular release. The lateral patellofemoral ligament is a significant stabilizer for medial and lateral patellar displacement, and soft tissue–based reconstruction may restore its stabilizing effect. Indications: Lateral patellofemoral ligament reconstruction (LPFLR) is indicated for patellar instability failing exhaustive nonoperative measures. Technique Description: Diagnostic arthroscopy for medial patellofemoral ligament (MPFL) status, patellar tracking, chondral status, and postoperative changes of lateral retinacular release is conducted. A 5-cm incision is made between the midpoint of the patella and the lateral epicondyle, or a single midline incision can be used if performing a concomitant MPFL reconstruction. Dissection is carried down to the lateral retinaculum and capsule, and two 1-cm incisions are made at the distal and proximal patella through the patellar and quadriceps tendon, respectively. The lateral epicondyle is then directly palpated, and two 1-cm incisions are made directly anterior and posterior to the epicondyle into the iliotibial band in full extension. A hamstring allograft is then shuttled in a V-shaped configuration from the quadriceps tendon through the iliotibial band and finally to the patellar tendon. Excess graft is trimmed and doubled over proximally and distally to replicate the normal (or contralateral) 0° to 15° of patellar eversion. Trial resting length and tension is set with temporary sutures through the proximal and distal doubled graft in full extension. The knee is taken through full range of motion to ensure there is no graft tightening in flexion or loosening in full extension. Eversion and patellar translation are then examined. Heavy nonabsorbable sutures are used to set length of the doubled allograft proximally and distally. Results: Case series of LPFLR have demonstrated significant improvements in patients’ pain, Lysholm score and Knee Injury and Osteoarthritis Outcome Score, and kinesiophobia with no instability events and normal range of motion at short-term follow-up. Discussion/Conclusion: Medial patellar instability can occur following lateral retinacular release and patients experiencing instability despite nonoperative treatment are likely to benefit from a soft tissue–based LPFLR. Although other nongraft-based techniques may confer similar outcomes, the authors find it more reliable to perform a lateral reconstruction as described.
format	article
author	Hailey P. Huddleston MD Navya Dandu BS Blake M. Bodendorfer MD Adam B. Yanke MD, PhD
author_facet	Hailey P. Huddleston MD Navya Dandu BS Blake M. Bodendorfer MD Adam B. Yanke MD, PhD
author_sort	Hailey P. Huddleston MD
title	Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft
title_short	Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft
title_full	Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft
title_fullStr	Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft
title_full_unstemmed	Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft
title_sort	lateral patellofemoral ligament reconstruction with a hamstring allograft
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/75200ff1301244b993c77fdb137cb36d
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Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft

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