By Douglas W. Jackson
Memorial scientific middle, lengthy seashore, CA. Updates the operations, and introduces many new approaches. contains new chapters on meniscal fixation, meniscal transplantation, cruciate graft harvesting, microfracture, and extra. colour illustrations. earlier version: c1995. DNLM: Knee Injuries--surgery.
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Extra resources for Master Techniques in Orthopaedic Surgery Reconstructive Knee Surgery
Some authors recommend MPFL repair for patients following their first patellar dislocation (15). We usually recommend treating an initial dislocation episode nonoperatively, but will repair an acute MPFL tear when surgery is necessary for concomitant intra-articular pathology (large loose body, meniscus tear). MPFL repair techniques may also be used to treat recurrent instability. The MPFL becomes attenuated and functionally incompetent with repeated instability episodes, so it is tightened by cutting, shortening, and reattaching it at the patellar or femoral insertion, or by midsubstance imbrication.
A: Central tracking. B: Correction of lateral overhang. 9 FIGURE 1-9 The patella should be manually everted 90 degrees to confirm adequate lateral release. Pearls and Pitfalls Lateral release should be performed only with the appropriate surgical indications. A slight bend made near the tip of the radiofrequency probe facilitates ease of lateral release. Avoid injury to the muscle fibers of the vastus lateralis proximally. Mechanical debridement of the fat pad around the anterolateral portal improves visualization and ensures an adequate distal release.
Cosgarea Brett M. Cascio INDICATIONS Over the years, a large number of procedures have been described to treat patellar instability. Recently there has been a great deal of interest in procedures that address the medial patellofemoral ligament (MPFL), the primary soft tissue passive restraint to pathologic lateral patellar displacement (2,4). The MPFL is torn when the patella dislocates (10,15), and a variety of techniques have been described to repair (3,10,15) or reconstruct (5,12,16) the ligament in an attempt to restore its function as a checkrein.