Medial quadriceps tendon femoral ligament reconstruction seen as option to medial patellofemoral ligament reconstruction

Andrew J. Cosgarea

LAS VEGAS — Medial quadriceps tendon femoral ligament reconstruction may be a valid alternative to medial patellofemoral ligament reconstruction, according to a presenter at the Arthroscopy Association of North American and American Orthopaedic Society for Sports Medicine Specialty Day at the American Academy of Orthopaedic Surgeons Annual Meeting.

Perspective from Sabrina M. Strickland, MD

“[Medial quadriceps tendon femoral ligament] MQTFL reconstruction is an alternative to the more traditional [medial patellofemoral ligament] MPFL reconstruction technique, although published clinical outcome studies remain limited at this time,” Andrew J. Cosgarea, MD, told Healio.com/Orthopedics.

Cosgarea said when he and his colleagues compared techniques with the MPFL, medial patellofemoral complex and MQTFL, the MPFL and MPFC limited lateral patellar maltracking and decreased the length of the MQTFL. Also, the MPFL and medial patellofemoral complex decreased maximum contact pressure which reduced the length of the MQTFL and provided similar results.

“According to unpublished computational modeling data from [John J.] Elias, [PhD,] both MPFL and MQTFL techniques can normalize tracking and joint contact pressure when the grafts are placed anatomically,” Cosgarea said.

He said there was no single optimal technique and that there are many ways to perform reconstruction.

“I perform MPFL reconstruction for recurrent patella instability when

there is not substantial malalignment,” Cosgarea said. “MPFL reconstruction predictably stabilizes the patella with a low risk of patella fracture when performed using a shallow socket for graft fixation on the patella.”

Cosgarea prefers to perform MPFL reconstruction but noted that other orthopedic surgeons have found the MQTFL to be successful. Cosgarea uses MPFL in most patients; however, he said he would consider MQTFL in some patients who need revision. – by Monica Jaramillo

Reference:

Cosgarea AJ. MPFL vs. MQTFL: What I do and why. Presented at: Arthroscopy Association of North American and American Orthopaedic Society for Sports Medicine Specialty Day at the American Academy of Orthopaedic Surgeons Annual Meeting; March 16, 2019; Las Vegas.

Disclosure: Cosgarea reports no relevant financial disclosures.

Perspective

Sabrina M. Strickland, MD

There have been a dizzying number of studies in recent literature describing ways to stabilize the patella in patients with patellar instability. Data definitely support ligament reconstruction in cases of recurrent instability, and more recent studies suggest that patients with first-time dislocations may be surgical candidates if they meet certain criteria.

At the recent Arthroscopy Association of North American and American Orthopaedic Society for Sports Medicine Specialty Day at the American Academy of Orthopaedic Surgeons Annual Meeting, Andrew Cosagarea, MD, discussed a modification of the MPFL — the MQTFL, where the tendon is passed around the medial quad tendon instead of violating the patella and risking patella fracture. Early research suggests that the results may be the same with both techniques and at this point, I would suggest that surgeons perform the technique with which they are most comfortable.

Sabrina M. Strickland, MD

Orthopedic surgery, sports medicine

Hospital for Special Surgery

New York

Disclosures: Strickland reports no relevant financial disclosures.