Reconstruction of the Middle Patelofemoral Ligament with Quadricipital Autoinjerto and Use of the 3D Preoperative TAC to establish Femoral Anatomic Point

摘要

Objectives: In recent years, the reconstruction of the LPFM has gained importance. The most used technique is with autograft of hamstring tendons. In some series, reports of complications are greater than 26%. This work aims to demonstrate the utility of the quadriceps autograft for the reconstruction of the LPFM, without patellar tunnels and without the use of intraoperative fluoroscopy. Methods: Patients with a clinical history of at least two episodes of dislocation were included. Radiographic series, axial CT, patellae, 3D CT and MRI were taken in all patients. 24 patients, 16 women and 8 men, with an average age of 23 years, met the selection criteria. Results: In our study we observed the improvement of scores on the scales of Lysholm, Tegner and Kujala in the postoperative period with controls at 6, 12 and 18 months. No new episodes of patellar dislocation or other relevant complications. There was a return in all cases to sports activity. Conclusion: This study reaffirms that the quadriceps tendon is a graft that reproduces better the anatomy of the LPFM, presents figures comparable or better functionally with the other grafts used at present. With the preoperative protocol of TAC3D, the adductor and medial epicondyle tubules have been identified individually and with the anatomical specificity of each patient, giving greater certainty in the anatomical location of the LPFM femoral insert. With the additional advantages of decreasing surgical time, and avoiding unnecessary radiation in the surgical team.