Medial patellofemoral ligament reconstruction: A novel technique using the patellar ligament

fit patients with chronic patellofemoral instability, more than 2 episode,, of dislocation, and an anterior tuberosity trochlear groove of less than 20 mm its measured oil computed tomography or nuclear magnetic resonance in-raging. we have developed it technique for medial patellotemoral ligament reconstruction that uses a medial strip of the patellar ligament (PL). The incision started proximally at the level of the superior margin of the patella, centrally between the patellar medial margin and the medial epicondyle. A descending incision wits then made, directed toward the superomedial margin of the tibial tubercle. We performed a plane-by-plane dissection up to the peritenon of the Pl. With an osteotome, we Could remove a 2-cm bone fragment concerning, the medial third of the distal insertion of the PL or keep the distal end free. Using a No. 11 scalpel blade, we carefully detached the PL from the patella Lip to the transition between the proximal third and medial third of the patella. We placed the stitches between the periosteum and the ligament using FiberWire absorbable threads (Arthrex, Naples, FL.) to safely rotate the graft. After that, we dissected the medial capsule and approached the femoral medial epicondyle. Then we gat placed it Krackow suture in the free tendon end using absorbable threads or anchored the threads into 2 holes that were previously drilled, and we secured the end with all absorbable interference screw or anchors. The fixation should be performed with the knee at 15 degrees to 30 degrees of flexion. Then we sutured the distal edge of the vastus medialis muscle to the graft, which bestows it dynamic component upon the reconstruction. and we immobilized the knee with a removable brace.