The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Plantaris Tendon Autograft Can Restore Patellar Stability in Adolescent Medial Patellofemoral Ligament Reconstruction: A Technical Note

Document Type : TECHNICAL NOTE

Authors
Josip Vlaic 1
Mario Josipovic 2
Dinko Nizic 3
Marko Simunovic 4
Zdravko Schauperl 5
Mislav Jelic 2
1 1 Division of Paediatric Orthopaedic Surgery, Children’s Hospital Zagreb, Zagreb, Croatia 2 School of Medicine, University of Zagreb, Zagreb, Croatia
2 2 School of Medicine, University of Zagreb, Zagreb, Croatia 3 Department of Orthopaedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
3 Department of Radiology and Ultrasound Diagnostics, Special Hospital for Pulmonary Diseases, Zagreb, Croatia
4 Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
5 Department of Materials, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
10.22038/abjs.2024.75154.3476
Abstract
Medial patellofemoral ligament reconstruction is a standard treatment option for patients with patellar 
instability. The main purpose of this study was to determine whether isolated anatomic medial 
patellofemoral ligament reconstruction using double folded, four-strand plantaris tendon autograft restores 
patellar stability in adolescent patients. Plantaris tendon autografts were harvested through proximal 
approach and used in four adolescent patients. A four-strand autograft was prepared in a double-limbed 
configuration and fixed on the patella and the femur with suture anchors and interference screws, 
respectively. The mean Kujala score improved significantly from 44 ± 24 SD (range, 19 to 69) points 
preoperatively to 94 ± 10 SD (range, 78 to 100) points postoperatively (P< 0.001). All patients reported 
excellent subjective outcomes and returned to their pre-injury level of sporting activities. The use of a 
four-strand plantaris tendon autograft in isolated anatomic medial patellofemoral ligament reconstructi on 
can restore patellar stability in adolescents. 
Level of evidence: IV
Keywords
Adolescents
Autograft
Medial patellofemoral ligament reconstruction
Patellar instability
Plantaris tendon
Subjects
  1. Mountney J, Senavongse W, Amis AA, Thomas NP. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br.2005; 87:36-40.
  2. Yeung M, Leblanc MC, Ayeni OR, et al. Indications for Medial Patellofemoral Ligament Reconstruction: A Systematic Review. J Knee Surg. 2016; 29:543-554. doi: 10.1055/s-0035-1564730.
  3. McNeilan RJ, Everhart JS, Mescher PK, Abouljoud M, Magnussen RA, Flanigan DC. Graft choice in isolated medial patellofemoral ligament reconstruction: a systematic review with meta-analysis of rates of recurrent instability and patient-reported outcomes for autograft, allograft, and synthetic options. Arthroscopy. 2018; 34:1340-1354. doi: 10.1016/j.arthro.2017.11.027.
  4. Sidharthan S, Wang G, Schlichte LM, Fulkerson JP, Green DW. Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients. JBJS Essent Surg Tech. 2020; 10:1-3. doi: 10.2106/JBJS.ST.18.00110.
  5. VandenBerg CD, Sarkisova N, Pace JL, et al. Current practice trends in the surgical management of patellofemoral instability: a survey of the Paediatric Research in Sports Medicine (PRiSM) Society. J Child Orthop. 2021; 15:571-576. doi: 10.1302/1863-2548.15.210084.
  6. Migliorini F, Maffulli N, Bell A, Betsch M Outcomes, return to sport, and failures of MPFL reconstruction using autografts in children and adolescents with recurrent patellofemoral instability: A systematic review. Children (Basel). 2022; 9:1892. doi: 10.3390/children9121892.
  7. Schepsis AA, Rogers AJ. Medial patellofemoral ligament reconstruction: indications and technique. Sports Med Arthrosc Rev. 2012; 20:162-170. doi: 10.1097/JSA.0b013e318264188b.
  8. Gfoller P, Hoser C, Runer A, Abermann E, Wierer G, Fink C. Medial patellofemoral ligament (MPFL) reconstruction using quadriceps tendon autograft provides good clinical, functional and patient-reported outcome measurements (PROM): a 2-year prospective study. Knee Surg Sports Traumatol Arthrosc. 2019; 27:2426-2432. doi: 10.1007/s00167-018-5226-6.
  9. Sanchis-Alfonso V, Montesinos-Berry E, Ramirez-Fuentes C, Leal-Blanquet J, Gelber PE, Monllau JC. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies. World J Orthop 2017; 8:115-129. doi:10.5312/wjo.v8.i2.115
  10. Silver RL, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg Br. 1985; 67:432-437. doi: 10.1302/0301-620X.67B3.3997956.
  11. Spina AA. The plantaris muscle: anatomy, injury, imaging, and treatment. J Can Chiropr Assoc. 2007; 51:158-165.
  12. Vlaic J, Josipovic M, Bohacek I, Jelic M. The plantaris muscle: too important to be forgotten. A review of evolution, anatomy, clinical implications and biomechanical properties. 2019; 59:839-845. doi: 10.23736/S0022-4707.18.08816-3.
  13. Pagenstert GI, Hintermann B. Proximal mini-invasive grafting of plantaris tendon. In: Easley ME, Wiesel SW, editors. Operative Techniques in Foot and Ankle Surgery, Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer business; 2011.
  14. Miller TT, Staron RB, Feldman F. Patellar height on sagittal MR imaging of the knee. AJR Am J Roentgenol. 1996; 167:339-341. doi: 10.2214/ajr.167.2.8686598.
  15. Dejour DH. The patellofemoral joint and its historical roots: the Lyon School of Knee Surgery. Knee Surg Sports Traumatol Arthrosc. 2013; 21:1482-1494. doi: 10.1007/s00167-012-2331-9.
  16. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy. 1993; 9:159-163. doi: 10.1016/s0749-8063(05)80366-4.
  17. O'Connor CM, Ring D. Correlation of single assessment numeric evaluation (SANE) with other patient reported outcome measures (PROMs). Arch Bone Jt Surg. 2019; 7:303-306.
  18. Zarzycki W, Mazurkiewicz S, Wisniewski P. Research on strength of the grafts that are used in anterior cruciate ligament reconstruction. Pol Orthop Traumatol. 1999; 64:293-302.
  19. Bohnsack M, Surie B, Kirsch IL, Wulker N. Biomechanical properties of commonly used autogenous transplants in the surgical treatment of chronic lateral ankle instability. Foot Ankle Int. 2002; 23:661-664. doi: 10.1177/107110070202300714.
  20. Vlaic J, Josipovic M, Bohacek I, et al. Plantaris tendon is valuable graft for the medial patellofemoral ligament reconstruction: A biomechanical study. Knee. 2022; 38:212-219. doi: 10.1016/j.knee.2022.08.016.

 

 

  1. Schottle P, Schmeling A, Romero J, Weiler A. Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg. 2009; 129:305-309. doi: 10.1007/s00402-008-0712-9.
  2. Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med. 2007; 35:801-804. doi: 10.1177/0363546506296415.
  3. Josipović M, Vlaić J, Serdar J, et al. Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures Knee Surg Sports Traumatol Arthrosc. 2020; 28:2604-2608. doi: 10.1007/s00167-020-05885-x.
  4. Placella G, Tei M, Sebastiani E, et al. Anatomy of the medial patello-femoral ligament: a systematic review of the last 20 years literature. Musculoskelet Surg. 2015; 99:93-103. doi: 10.1007/s12306-014-0335-y.
  5. Weinberger JM, Fabricant PD, Taylor SA, Mei JY, Jones KJ. Influence of graft source and configuration on revision rate and patient-reported outcomes after MPFL reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017; 25:2511-2519. doi: 10.1007/s00167-016-4006-4.
  6. Arendt EA. Anatomy and biomechanics of the patellar ligaments. Tecniche Chirurgiche in Ortopedia E Traumatologia .2007; 5:13-18.
  7. Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, Bonanzinga T, Marcacci M. Minimally invasive medial patellofemoral ligament reconstruction with fascia lata allograft: surgical technique. Knee Surg Sports Traumatol Arthrosc. 2014; 22:2426-2430. doi: 10.1007/s00167-014-2940-6.
  8. Nordin JS, Olsson O, Lunsjo K. The gracilis tendon autograft is a safe choice for orthopedic reconstructive procedures: a consecutive case series studying the effects of tendon harvesting. BMC Musculoskelet Disord. 2019; 20:138. doi: 10.1186/s12891-019-2520-5.
  9. Adams DJ, Mazzocca AD, Fulkerson JP. Residual strength of the quadriceps versus patellar tendon after harvesting a central free tendon graft. Arthroscopy. 2006; 22:76-79. doi: 10.1016/j.arthro.2005.10.015.

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 4
April 2024
Pages 283-288

  • Receive Date 26 September 2023
  • Revise Date 20 January 2024
  • Accept Date 02 March 2024