Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft

Area of Science:

• Orthopedic surgery
• Sports medicine
• Knee biomechanics

Background:

• Medial patellar instability is a rare complication following lateral retinacular release surgery.
• The lateral patellofemoral ligament (LPFL) is crucial for stabilizing the patella against medial and lateral displacement.
• Soft tissue reconstruction of the LPFL can potentially restore patellar stability.

Purpose of the Study:

• To describe the surgical technique for lateral patellofemoral ligament reconstruction (LPFLR) using a hamstring allograft.
• To evaluate the efficacy of LPFLR in patients with patellar instability refractory to nonoperative management.

Main Methods:

• Diagnostic arthroscopy to assess the medial patellofemoral ligament, patellar tracking, and chondral status.
• A V-shaped hamstring allograft is harvested and tunneled through the quadriceps and patellar tendons and iliotibial band.
• Graft fixation with nonabsorbable sutures to achieve optimal resting length and tension, replicating natural patellar eversion.

Main Results:

• Case series demonstrated significant improvements in patient-reported outcomes, including pain, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score (KOOS).
• Patients reported reduced kinesiophobia (fear of movement) post-surgery.
• No recurrent instability events or loss of range of motion were observed at short-term follow-up.

Conclusions:

• Lateral patellofemoral ligament reconstruction (LPFLR) is a viable soft tissue option for medial patellar instability post-lateral retinacular release.
• Patients with persistent instability despite nonoperative treatment may benefit significantly from LPFLR.
• The described technique offers a reliable method for restoring lateral patellofemoral stability.