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Related Concept Videos

Bones of the Lower Limb: Femur and Patella01:16

Bones of the Lower Limb: Femur and Patella

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The femur is the body's longest and strongest bone spanning the thigh region. Its head articulates with the acetabulum of the hip bone to form the hip joint. A minor indentation on the medial side of the femoral head, called the fovea capitis, serves as the site of attachment for the ligament of the head of the femur. This weak ligament spans the femur and acetabulum and supports the hip joint. The narrowed region below the head is the neck of the femur. The inclination angle between the...
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Knee Joint01:23

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The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
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Updated: May 9, 2025

Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts
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Complex Patellofemoral Reconstruction for Recurrent Instability.

Edward R Floyd1,2, Nicholas I Kennedy3, Adam J Tagliero3

  • 1Twin Cities Orthopedics, Edina-Crosstown, Edina, Minnesota, USA.

Video Journal of Sports Medicine
|May 1, 2025
PubMed
Summary
This summary is machine-generated.

This study presents a surgical technique combining medial patellofemoral ligament (MPFL) reconstruction with tibial tubercle osteotomy (TTO) and trochleoplasty for recurrent patellar instability. The procedure effectively restores patellar tracking and eliminates subluxation, improving patient outcomes.

Keywords:
MPFL reconstructionmedial patellofemoral ligamentpatellofemoral disorderstibial tubercle to trochlear groove distancetrochlear dysplasia

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Biomechanical Engineering

Background:

  • Patellofemoral instability results from combined bony and soft tissue factors, including patellar height, tibial tubercle (TT) lateralization, and trochlear dysplasia.
  • Assessing factors like TT-TG distance, Caton-Deschamps Index, and patellar trochlear index (PTI) is crucial for evaluating patellar alignment and stability.
  • Soft tissue restraints, such as the medial quadriceps tendon femoral ligament (MQFL), play a significant role in preventing lateral patellar subluxation.

Purpose of the Study:

  • To describe a surgical technique for managing recurrent patellar instability in patients with moderate-to-severe trochlear dysplasia.
  • To evaluate the efficacy of combining medial patellofemoral ligament (MPFL) reconstruction with tibial tubercle osteotomy (TTO) and sulcus-deepening trochleoplasty.
  • To restore normal patellar tracking and eliminate recurrent subluxation.

Main Methods:

  • The surgical technique involves MPFL reconstruction using a quadriceps tendon graft, followed by TTO to correct TT position.
  • A V-shaped flap of trochlear cartilage is created and secured to deepen the trochlear groove (sulcus-deepening trochleoplasty).
  • The procedure includes fluoroscopic verification of screw depth and location for TT fixation and assessment of patellar tracking before closure.

Main Results:

  • Sulcus-deepening trochleoplasty, with or without MPFL reconstruction, has shown satisfactory outcomes, with up to 85% return to sport and 100% return to work.
  • MPFL reconstruction combined with TTO has reported a 94.5% patient satisfaction rate in existing literature.
  • The combined technique aims to eliminate recurrent patellar subluxation and improve patellar tracking.

Conclusions:

  • MPFL reconstruction with TTO and sulcus-deepening trochleoplasty offers excellent subjective outcomes for patients with recurrent patellar instability and Dejour types B-D trochlear dysplasia.
  • This surgical approach effectively restores patellar tracking and eliminates recurrent subluxation.
  • The procedure leads to significant improvements in functional scores, such as the International Knee Documentation Committee (IKDC) scores.