Kneecap (Patellar) Instability: Ligament Reconstruction Using Soft Anchors and Screws

Achilles Tendinitis: Bone Spur Removal and Minimally Invasive Achilles Tendon Repair Animation

This video is a cadaveric demonstration of an M P F L reconstruction using a tendon graft, soft body anchors, and an absorbable screw. Here we have a right knee. The outer side of the knee is at the top of the screen, while the inner side of the knee is at the bottom of the screen.

The surgeon begins by making an incision through the skin and soft tissue along the inner border of the kneecap. Once exposed, the surgeon will use a burr to prepare the bone surface where the graft will attach. Next, the surgeon will begin placing anchors into the kneecap. The surgeon inserts a drill into a drill guide to create a socket into the side of the kneecap. Then, the first anchor is inserted into the drill guide and tapped in place.

The anchor has 2 types of suture tapes attached. Applying tension to the black suture tapes helps to ball up the anchor under the bone to hold it in place. The ends of these suture tapes will also be used to close up the soft tissue around the kneecap at the end of the procedure. The blue suture tape has a loop already in place. This loop will be used to secure the MPFL graft to the kneecap without having to tie knots. The surgeon will repeat the same steps for the second anchor.

Next, the surgeon will secure a tendon graft, taken either from the patient or from a cadaver, to place along the inner border of the kneecap. Once the graft is obtained, the surgeon will slide the graft through the suture loops and apply tension to the blue sutures to secure the graft to the kneecap. Once the graft is secured in place, the surgeon will sew both ends of the graft together with sutures.

X-ray is used during the procedure to locate the attachment site for the MPFL along the inner side of the thigh. Once it is correctly identified, the surgeon will make a small incision through the skin and soft tissue along the inner side of the thigh. Then, the surgeon will drill a guide pin into the thigh bone to create a small tunnel that exits out the other side of the thigh. The surgeon will also use a reamer to create a wider socket at the beginning of this tunnel where the absorbable screw will be placed.

A passing suture is then passed under the skin and secured to the ends of the graft to pull the graft toward the tunnel in the thigh bone. This passing suture is then connected to a guide wire, which is used to pull the graft into the prepared socket. The surgeon will move the knee to check the tension of the graft to make sure the kneecap is not being pulled inward too much. Once the ideal alignment is achieved, the surgeon inserts the absorbable screw into the inner side of the thigh bone to secure the tendon graft in place.

The surgeon bends and straightens the knee to recheck the tension of the graft and alignment of the kneecap. After the procedure is complete, the surgeon will use the black suture tapes to close the soft tissue around the kneecap and then use additional sutures to close the skin incisions.