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1、Case Discussion,Zhao Zhang, Meng Wu, Shengli She, 521 Hospital, Xian, China,Preoperative X-ray,M，23y， Sprains result to left knee joint discomfort and pain for six years, add 2 days.,Specialized examination: Patients with ministry of knee swelling, Patellar Tenderness positive, Floating Patellar Tes
2、t positive, Fear Test is positive, the Q Angle of 20 , Knee activity limited.,Preoperative CT-scan,Preoperative CT-scanc,Preoperative CT-scanc,TT-TG value,Diagnosis,Post-op,Post-op,3m-op,The admitting diagnosis : Recurrent patellar dislocation in leg knee,Treatment plan,The medial patellar ligament
3、reconstruction + lateral ligament release.,Intraoperative arthroscopy,Intraoperative- radioscopy,Hamstring tendons,Tunnel Positioning,Tunnel Positioning,Intraoperative release of the lateral ligaments,Reattachment state,Postoperative X-ray,4 Months after operation,Trauma result to left knee joint di
4、scomfort and pain,CT-scan,How?,Plan?,Type of Patellar fracture after MPFL Type-I：fractures are transverse fractures through the patellar tunnel or drill hole which are customarily treated with tension-band wiring . Type-II: fractures are superior pole fractures, or sleeve avulsion fractures.,Review
5、of the literature,1.Patellar Fracture After Medial Patellofemoral Ligament Surgery. Shital N. Parikh, MD, and Eric J. Wall, MD. J Bone Joint Surg Am. 2011;93:e97(1-8) 。2. Avoiding Complications in Patellofemoral Surgery Ryan K. Harrison, MD, Robert A. Sports Med Arthrosc Rev 2013;21:121128),type-III
6、：fractures are medial rim avulsion fractures through drill holes in the patella, associated with recurrent lateral patellar dislocation after patellar stabilization procedures.,Review of the literature,Patellar Fracture After Medial Patellofemoral Ligament Surgery. Shital N. Parikh, MD, and Eric J.
7、Wall, MD. J Bone Joint Surg Am. 2011;93:e97(1-8) d,Treatment methods,Plaster Fixation 1 month. After 2 months?,6 Months after operation,Limb function,Summary,Factors Crucial for Successful Reconstruction,Complications of Medial Patellofemoral Ligament Reconstruction: Common Technical Errors and Fact
8、ors for Success. Miho J. Tanaka, MD, Matthew J. Bollier, MD, Jack T.THE JOURNAL OF BONE 94:e87(1-8).,The patellar tunnel should be drilled without violation of the anterior cortex or articular surface. Digital palpation of the articular surface while drilling the patellar tunnel can be helpful in di
9、recting the tunnel appropriately.Because the femoral tunnel can be difficult to place in the correct position, a larger incision with greater exposure or fluoroscopic visualization can aid in correct tunnel placement.,Summary,Appropriate graft tensioning is crucial for a successful medial patellofem
10、oral ligament reconstruction.The reconstructed medial patellofemoral ligament should allow two to three patellar quadrants of translationb, without overly constraining the patella.Comparison with the contralateral, normal side can be helpful in determining appropriate graft tension.Tensioning the gr
11、aft with the knee in flexion, with the patella captured within the trochlear groove, can help to prevent overtightening of the graft.,Factors Crucial for Successful Reconstruction,Complications of Medial Patellofemoral Ligament Reconstruction: Common Technical Errors and Factors for Success. Miho J.
12、 Tanaka, MD, Matthew J. Bollier, MD, Jack T.THE JOURNAL OF BONE 94:e87(1-8).,Summary,Medial patellofemoral ligament reconstruction is a viable option for correcting lateral patellofemoral instability without substantial malalignment. Many of the complications that can arise from this procedure are t
13、he result of technical surgical error and can be avoided by adherence to the following main principles.,1.Ahmad CS, Brown GD, Stein BS. The docking technique for medial patellofemoral ligament reconstruction: surgical technique and clinical outcome. Am J Sports Med. 2009;37:2021-7. Epub 2009 Jun 22.2. Complications of Medial Patellofemoral Ligament Reconstruction: Common Technical Errors and Factors for Success. Miho J. Tanaka, MD, Matthew J. Bollier, MD, Jack T.THE JOURNAL OF BONE 94:e87(1-8).,Factors Crucial for Successful Reconstruction,Thank you for attention.,
