MPFL Reconstruction: Tips and Tricks for a Successful Outcome O - PowerPoint PPT Presentation

MPFL Reconstruction: Tips and Tricks for a Successful Outcome O RTHOPAEDIC SUMMIT 2017 EVOLVING TECHNIQUES Beth E. Shubin Stein, MD Associate Professor Weill Cornell Medical College Sports Medicine & Shoulder Surgery Hospital for Special Surgery

DISCLOSURE I, Beth E. Shubin Stein, have NO relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation as follows:

MPFL Technical Points • MPFL Isometry – Through first 50 degrees then loosens • Femur is key • How do I find the ‘Right Spot’ – 1-Anatomy, 2-Isometry, 3- Image confirmation

MPFL Technical Points • MPFL Isometry – Through first 50 degrees then loosens • Femur is key • How do I find the ‘Right Spot’ – 1-Anatomy, 2-Isometry, 3- Image confirmation

MPFL Technical Points • MPFL Isometry – Through first 50 degrees then loosens • Femur is key • How do I find the ‘Right Spot’ – 1-Anatomy, 2-Isometry, 3- Image confirmation

MPFL Technical Points • MPFL Isometry – Through first 50 degrees then loosens • Femur is key • How do I find the ‘Right Spot’ – 1-Anatomy, 2-Isometry, 3- Imaging confirmation

MPFL Anatomy • Originates sadle between adductor tubercle and medial epicondyle AT ME

MPFL Technical Points • MPFL Isometry – Through first 50 degrees then loosens • Femur is key • How do I find the ‘Right Spot’ – 1-Anatomy, 2-Isometry, 3- Image confirmation

MPFL Technical Points • MPFL Isometry – Through first 50 degrees then loosens • Femur is key • How do I find the ‘Right Spot’ – 1-Anatomy, 2-Isometry, 3- Image confirmation

Complications

MPFL Complications • Patella – fracture is major complication

MPFL Docking Technique • Advantages – Short (20mm) blind tunnel • 4-5mm diameter – No anchors or screws – Strong fixation • Disadvantages – Risk of patella fracture • Avoid anterior tunnel

Complications

MPFL Complications • Femur – Malpositioned tunnel leading to increased loads and potential OA – Leads to increased anisometry and eventual failure or loosening of graft

How Do I Deal with Complications? • What’s the problem? – Instability – Stiffness – OA/ Pain • Figure out what went wrong the first time

MPFL Avoiding Complications • Avoid tunnels on patella • Use anatomic landmarks on femur • Check Isometry • Set length with knee in flexion (~30-45 ) – patella engaged in trochlea (longest length) to avoid over tensioning

MPFL Avoiding Complications • Avoid tunnels on patella • Use anatomic landmarks on femur • Check Isometry • Set length with knee in flexion (~30-45 ) – patella engaged in trochlea (longest length) to avoid over tensioning

MPFL Avoiding Complications • Avoid tunnels on patella • Use anatomic landmarks on femur • Check Isometry • Set length with knee in flexion (~30-45 ) – patella engaged in trochlea (longest length) to avoid over tensioning

MPFL Avoiding Complications • Avoid tunnels on patella • Use anatomic landmarks on femur • Check Isometry • Set length with knee in flexion (~30-45 ) – patella engaged in trochlea (longest length) to avoid over tensioning

Thank You