Medial Patellofemoral Complex Reconstruction Using the Rectus Femoris Tendon.

Abstract

The medial proximal static stabilizers of the patella are the medial patellofemoral ligament (MPFL) and the medial quadriceps tendon femoral ligament. These are collectively referred to as the "medial patellofemoral complex" (MPFC). MPFL reconstruction is the workhorse of patellar stabilization surgery for recurrent lateral instability. We describe a technique for reconstructing the MPFC using the ipsilateral rectus tendon. The tendon is harvested via a curved superomedial incision using an open stripper, preserving its distal attachment. The tendon is prepared, flipped, and passed in the sub-vastus space toward the medial femoral epicondyle. A small longitudinal incision is used to retrieve the tendon. The anatomic attachment of the MPFC is identified using both palpatory and radiographic landmarks. A 25-mm-long loop of tendon is sutured and docked within a socket of the same diameter. Fixation is performed using a 7 × 25-mm interference screw with the knee in 20° of flexion and lateral patellar glide. This limb reconstructs the medial quadriceps tendon femoral ligament component. The rest of the tendon is shuttled back to the superomedial patella in the previous tissue plane and fixed at the junction of the proximal and middle thirds of the patella using a 2.8-mm suture anchor. This limb reconstructs the MPFL.