Physeal-Sparing MPFL Reconstruction Technique With Lateral Retinaculum Lengthening

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Sports Medicine

Background:

• Medial patellofemoral ligament (MPFL) reconstruction in skeletally immature patients presents challenges due to the proximity of the femoral physis.
• Existing techniques struggle to balance anatomical graft placement with physeal preservation.

Purpose of the Study:

• To describe a novel surgical technique for MPFL reconstruction in skeletally immature patients.
• To achieve anatomical graft placement using an all-epiphyseal femoral tunnel, avoiding the physis.

Main Methods:

• A technique is detailed involving fluoroscopic guidance to place a guide pin at Schottle's point.
• A blind-ended, all-epiphyseal tunnel is drilled through the epiphysis, avoiding the lateral femoral condyle and patellar tendon.
• Graft fixation is performed with an interference screw at 45-60° flexion.

Main Results:

• The described technique allows for anatomical placement of the MPFL graft using an all-epiphyseal tunnel.
• Patients experience very good outcomes with immediate physical therapy, full weightbearing, and range of motion without bracing.

Conclusions:

• This all-epiphyseal MPFL reconstruction technique effectively addresses the challenges of operating on skeletally immature patients.
• It enables anatomical graft placement while preserving the femoral physis, leading to excellent patient outcomes.