Medial Patellofemoral Ligament Reconstruction With a Single-Limb Allograft: A Reproducible and Effective Technique

Abstract

Background: Medial patellofemoral ligament (MPFL) injury occurs in up 96% of lateral patellar dislocations, commonly affecting those less than 20 years old. The MPFL can be reconstructed using either a double-limb or single-limb technique. While both techniques achieve similar patient outcomes, a single-limb technique may require less operative time. Indications: The MPFL reconstruction is indicated in patients with recurrent patellar subluxations, dislocations, or unresolved apprehension. Care should be exercised in identifying whether patients require additional procedures in addition to MPFL reconstruction such as tibial tubercle osteotomy or trochleoplasty. These considerations include TT-TG >17 to 20 mm and Dejour B/D trochlear dysplasia. Technique description: Following diagnostic arthroscopy, a medial peripatellar incision is made. Layers 1 and 2 are sharply dissected over the patellar periosteum, and tissue planes are subsequently developed using Metzenbaum scissors. A plane between layers 2 and 3 extending from the medial patella to the medial femoral epicondyle is developed. Using fluoroscopy, Schöttle point is identified, and a femoral tunnel is drilled. Two PEEK anchors are placed at the junction of the proximal one-third and distal two-thirds of the patella. In parallel, a tibialis anterior graft is sized, whipstitched, and tensioned on the back table. One end of the prepared graft is secured in the femoral tunnel with a PEEK tenodesis screw. The graft is then shuttled between layers 2 and 3, followed by fixation on the patellar side using the previously placed suture anchors. Isometry of the graft is confirmed under direct and arthroscopic visualization. Results: In multiple systematic reviews of single-limb versus double-limb MPFL reconstruction, no differences were observed in terms of patient-reported outcome scores, repeat dislocation, and reoperation. Furthermore, a recent meta-analysis suggests a trend toward less postoperative stiffness (1.2% vs 3.5%, P = .09) for single-bundle techniques. Discussion/conclusion: Single-limb MPFL reconstruction is reproducible and effective, with clinically satisfactory outcomes and low failure rates. Single-limb MPFL reconstruction demonstrates similar outcomes as double-limb reconstruction, with a potential decrease in surgical time and postoperative stiffness. Patient consent disclosure statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.