Technical notes
Minimally invasive “crescentic” imbrication of the medial patellofemoral ligament for chronic patellar subluxation

https://doi.org/10.1016/j.arthro.2004.10.008Get rights and content

Abstract

Chronic patellar subluxation is one of the many causes of anterior knee pain. Nonoperative management of this disorder is successful in many patients, but surgical intervention may be necessary for refractory cases. We present a surgical technique for chronic patellar subluxation that is minimally invasive and is focused specifically on the medial patellofemoral ligament.

Section snippets

Surgical technique

A tourniquet is applied to the thigh, and the leg is prepped and draped in the usual sterile manner. The leg is exsanguinated and the tourniquet is inflated. Routine arthroscopy of the knee is performed and a lateral retinacular release is completed either arthroscopically or through a small lateral incision. A 3-cm longitudinal skin incision, starting at approximately the level of the superior pole of the patella and extending distally, is placed 1 cm medial to the medial border of the patella

Discussion

The MPFL is located in layer 2 of the medial aspect of the knee. It originates from the anterior aspect of the medial epicondyle of the femur, immediately superior to the femoral attachment of the superficial MCL. The main insertion of the MPFL is the superior medial aspect of the patella. 1, 2, 12, 13, 14 Biomechanical studies have shown that the MPFL is the major restraint to lateral patellar translation. 1, 2

The primary pathoanatomy associated with acute lateral patellar dislocation is

Acknowledgment

The authors acknowledge the editorial assistance of Lisa Farina.

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