Ultrasound-Guided Percutaneous Repair of Medial Patellofemoral Ligament: Surgical Technique and Outcomes
A lateral patellar dislocation causes a medial patellofemoral ligament (MPFL) tear that begins affecting patellar biomechanics. Reconstruction is difficult because of the inability to reliably and accurately determine proper placement of sockets. Studies of MPFL anatomy have found significant variability in attachment site locations, which suggests MPFL procedures cannot be used universally and must be approached differently for each patient. Recurrent dislocations result in patellar and trochlear chondral and bony damage. In this article, we present a novel technique that uses ultrasound to locate the MPFL tear and the MPFL attachment sites, and perform anatomical repair of the native tissue at the patellar attachment site, the femoral attachment site, or both. We also describe our retrospective analysis of 10 cases of this ultrasound-guided percutaneous procedure, performed since its development in 2013. In each case, patellar stability was restored completely and without complications. The promising results, the ease of the surgery, and the limited rate of complications indicate this surgical technique should be considered before reconstruction and early in trauma cases, before onset of chondral or bony damage.
Conclusion
The MPFL is a vital static stabilizer of the patella and as such should be evaluated in the setting of patellar injury. The novel preoperative and intraoperative use of musculoskeletal ultrasound described in this article allows for easy real-time identification of the MPFL and simple and accurate percutaneous repair of torn structures. Nonoperative treatments of acute patellar dislocations have higher rates of recurrent dislocations, which put patella and trochlea at risk for bony and chondral damage. Given appropriate tear location and tissue quality, repairs should be considered early and before reconstruction. To our knowledge, a reliable, easily reproducible MPFL repair was not described until now. We have reported on use of such a technique and on its promising patient outcomes, which should be considered when addressing MPFL injuries.
Am J Orthop. 2017;46(3):152-157. Copyright Frontline Medical Communications Inc. 2017. All rights reserved.
