Medial Patellofemoral Ligament Reconstruction using Healicoil Anchors (Smith and Nephew)
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This is a presentation of the reconstruction of a medial patellofemoral ligament (MPFL) in a 31 year old female with recurrent patellar instability. The gracilis hamstring tendon is used and fixed using 4.5mm Healicoil PEEK bone anchors on the patellar side and Smith and Nephew Biosure PK interference screw in the femur.
The technique includes:
- the use of pre-operative arthroscopy to assess tracking and patellar articular integrity. This case shows very clearly that the knee needs to be assessed “dry” to truly reflect patellar in vivo tracking
- the use of an image intensifier to help identify the correct position for the isometric femoral tunnel
The operation utilises a graft to replace a damaged native medial patellofemoral ligament, a distinct thickening within the medial retinaculum. Recurrent lateral dislocation often leads to rupture and/or stretching of this defunctioned structure and risks further dislocations. Each episode is not only very uncomfortable but leads to long term irreversible chondral damage to the patellofemoral joint. Various options for reconstruction are available (listed below) but my preference is the hamstring graft as, in my hands it is a reproducible operation leading to excellent reduction in recurrent dislocation. The size, thickness and consistency of the gracilis tendon is the closest option to a direct replacement of the native MPFL. The graft acts as a check-rein to further dislocation. Soft tissue knee surgeons are quite familiar with hamstring harvesting from ACL reconstruction.
The use of Smith and Nephew Healicoil (PEEK) anchors carry several potential advantages including:
- avoiding drilling across the patella, thereby reducing the potential risk of patella fracture
- the fact that the modulus of elasticity of PEEK is close to bone reduces the risk of creating a stress riser in the patella
- excellent demonstrable pull out strength of this implant
- ease of use of the Healicoil.
Author: Andrew Pearse FRCS (Tr & Orth).
Institution: The Worcestershire Acute NHS Trusts, Uk.