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

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Sep 07, 2023 357 likes •575 views

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

SLIDE 1

MPFL Reconstruction:

Tips and Tricks for a Successful Outcome ORTHOPAEDIC SUMMIT 2017

EVOLVING TECHNIQUES Beth E. Shubin Stein, MD

Associate Professor Weill Cornell Medical College Sports Medicine & Shoulder Surgery Hospital for Special Surgery

SLIDE 2

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:

SLIDE 3

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

SLIDE 4

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

SLIDE 5

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

SLIDE 6

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

SLIDE 7

MPFL Anatomy

Originates sadle between

adductor tubercle and medial epicondyle

ME AT

SLIDE 8

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

SLIDE 9

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

SLIDE 10

Complications

SLIDE 11

MPFL Complications

Patella

– fracture is major complication

SLIDE 12

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

SLIDE 13

Complications

SLIDE 14

Femur

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

MPFL Complications

SLIDE 15

How Do I Deal with Complications?

What’s the problem?

– Instability – Stiffness – OA/ Pain

Figure out what went

wrong the first time

SLIDE 16

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

SLIDE 17

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

SLIDE 18

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

SLIDE 19

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

SLIDE 20

MPFL Reconstruction:

Tips and Tricks for a Successful Outcome ORTHOPAEDIC 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:

– Through first 50 degrees then loosens

Spot’

– 1-Anatomy, 2-Isometry, 3- Image confirmation

MPFL Technical Points

MPFL Technical Points

– Through first 50 degrees then loosens

Spot’

– 1-Anatomy, 2-Isometry, 3- Image confirmation

MPFL Technical Points

– Through first 50 degrees then loosens

Spot’

– 1-Anatomy, 2-Isometry, 3- Image confirmation

MPFL Technical Points

– Through first 50 degrees then loosens

Spot’

– 1-Anatomy, 2-Isometry, 3- Imaging confirmation

MPFL Anatomy

adductor tubercle and medial epicondyle

MPFL Technical Points

– Through first 50 degrees then loosens

Spot’

– 1-Anatomy, 2-Isometry, 3- Image confirmation

MPFL Technical Points

– Through first 50 degrees then loosens

Spot’

– 1-Anatomy, 2-Isometry, 3- Image confirmation

Complications

MPFL Complications

– fracture is major complication

MPFL Docking Technique

– Short (20mm) blind tunnel

– No anchors or screws – Strong fixation

– Risk of patella fracture

Complications

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

MPFL Complications

How Do I Deal with Complications?

– Instability – Stiffness – OA/ Pain

wrong the first time

MPFL Avoiding Complications

femur

(~30-45 )

– patella engaged in trochlea (longest length) to avoid over tensioning

MPFL Avoiding Complications

femur

(~30-45 )

– patella engaged in trochlea (longest length) to avoid over tensioning

MPFL Avoiding Complications

femur

(~30-45 )

– patella engaged in trochlea (longest length) to avoid over tensioning

MPFL Avoiding Complications

femur

(~30-45 )

– patella engaged in trochlea (longest length) to avoid over tensioning

Thank You