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[Anatomical double-bundle reconstruction of the medial patellofemoral ligament with a gracilis autograft].
[trochlear dysplasia]
Elimination
of
patellofemoral
instability
by
reconstruction
of
the
medial
patellofemoral
ligament
(
MPFL
)
with
a
gracilis
autograft
.
Recurring
lateral
luxation
and
subluxation
of
the
patella
,
tibial
tuberosity-trochlear
groove
distance
(
TTTG
)
<
 
20
Â
mm
,
persistent
positive
apprehension
test
in
up
to
45
°
of
flexion
,
low
grade
trochlear
dysplasia
.
Traumatic
luxation
of
the
patella
without
anatomical
risk
factors
,
isolated
treatment
if
TTTG
 
>
 
20
Â
mm
,
and
isolated
treatment
for
high
-grade
trochlear
dysplasia
(
type
B
,
C
,
D
)
.
Supine
postion
.
Stripping
of
the
gracilis
tendon
.
Drilling
of
two
tunnels
into
the
medial
margin
of
the
patella
.
Insertion
of
both
tendon
ends
into
the
tunnels
and
fixation
with
resorbable
screwlocks
.
Undermining
of
the
fascia
of
the
medial
oblique
vastus
muscle
and
insertion
of
the
tendon
loop
into
the
femoral
point
of
insertion
located
at
the
medial
epicondyle
.
Preparation
of
the
femoral
point
of
insertion
and
drilling
of
the
femoral
tunnel
.
Insertion
of
the
graft
into
the
femoral
tunnel
.
Positioning
of
the
knee
in
30
°
of
flexion
.
Positioning
of
the
patella
and
fixation
of
the
graft
with
a
resorbable
screw
.
Two
weeks
of
partial
weight
bearing
.
Knee
orthesis
for
6
Â
weeks
.
Passive
motion
up
to
60
°
of
flexion
for
the
first
2
Â
weeks
.
Three
weeks
postoperatively
unrestricted
motion
exercises
,
strengthening
of
the
quadriceps
muscle
.
Unlimited
activity
is
possible
3
months
postoperatively
.
The
method
presented
in
this
manuscript
was
performed
on
32
Â
patients
with
recurring
patellar
luxation
;
27
Â
patients
were
available
for
clinical
assessment
at
1
year
postoperatively
.
There
were
no
recorded
events
of
reluxation
;
the
Kujala
score
increased
on
average
from
61
points
preoperatively
to
93
points
postoperatively
.
