Percutaneous Reconstruction of the Medial Patello-Femoral Ligament Using Dynamic Gracilis Tendon Transfer

Background: Many techniques have been described for reconstructing the medial patello-femoral ligament (MPFL), using a variety of transplants and fixation methods to treat patello-femoral dislocation. The main challenge with static transfers is to position the femoral fixation point at the site that best restores MPFL anisometry. The objective of this cadaveric study was to propose a version of the initially described dynamic gracilis transfer technique that can be performed percutaneously. Hypothesis: Our working hypothesis was that using a minimally invasive approach would provide better cosmesis without altering the biomechanical efficacy of the procedure. Methods: 20 cadaveric knees were used to evaluate the feasibility and reliability of our percutaneous technique. We analysed femoral pulley location and scar length. Results: After dissection, the position of the femoral pulley allowed superimposition of the transplant along the trajectory of the native MPFL in all 20 knees. Cumulative scar length was 6.5 cm (range, 67.5 cm). Discussion: Percutaneous dynamic gracilis transfer is easy to perform, reproducible, and capable of creating a pulley that anatomically replicates the femoral insertion point of the native MPFL. Level of evidence: IV; retrospective study. (c) 2021 Elsevier Masson SAS. All rights reserved.

Automated summary

The study proposed a percutaneous dynamic gracilis transfer technique for medial patello-femoral ligament reconstruction and evaluated its feasibility on 20 cadaveric knees. Results showed that the technique was successful in all knees, indicating its potential as a minimally invasive approach for MPFL reconstruction.