Isolated reconstruction of the medial patellofemoral ligament with autologous quadriceps tendon

BACKGROUND: Since the role of the medial patellofemoral ligament (MPFL) as the primary soft-tissue restraint against lateral patellar translation has been recognized, several different reconstruction procedures for the treatment of patellar instability have been proposed over recent years. Many of these techniques require bony procedures and hardware fixation at the patellar and femoral side, leading to complications as described previously in the literature. The purpose of the present study is to describe the technique of isolated MPFL reconstruction using the quadriceps tendon and report the results at a mean follow-up of 38 months. The hypothesis is that this technique, not requiring drilling of bone tunnels on the patellar and femoral side, may be a "simple and safe" mean to manage patellar instability, giving good clinical results with low complication rate in selected patients with normal osseous anatomy. MATERIALS AND METHODS: Sixteen consecutive patients (9 male, 7 female; mean age 22 years) with chronic patellar instability underwent medial patellofemoral reconstruction with the superficial layer of the quadriceps tendon. All the patients were evaluated preoperatively and postoperatively by physical examination and subjectively with Kujala and Lysholm scores. RESULTS: The average follow-up was 38 months (range 28–48 months). No recurrent episodes of dislocation or subluxation and no complications occurred. The mean Kujala score increased from 35.8 preoperatively to 88.8 postoperatively and the Lysholm score improved from 43.3 preoperatively to 89.3 postoperatively. CONCLUSIONS: Isolated MPFL reconstruction using an autologous quadriceps tendon and not requiring bone tunnels, may be a safe, simple and effective procedure for the treatment of patellar instability without complications such as patellar fracture as reported by clinical studies using hamstring grafts. For the same reason it may also be indicated in skeletally immature patients. LEVEL OF EVIDENCE: Level IV.