A lateral patellotibial ligament reconstruction is performed for patients to undo the symptoms of medial patella instability after a lateral release. In those circumstances, the patients commonly have symptomatic medial patellar instability. A thorough clinical exam, as well as the use of reverse McConnell taping, can commonly help to decide if a patient’s symptoms are due to medial patellar instability after a lateral release.
Description of Lateral Patellotibial Ligament Reconstruction
The lateral patellotibial ligament reconstruction is performed to provide further restraint to the patella from recurrent medial patellar instability. In effect, it is reconstructing the distal aspect of the iliopatellar band that courses from the patella down to Gerdy’s tubercle on the tibia. The lateral patellotibial ligament reconstruction involves taking a lateral portion of the patellar tendon, leaving it attached to the patella and taking it off the tibial tubercle, and a portion of the iliotibial band, usually 8 mm wide and about 70 mm long, leaving it attached to Gerdy’s tubercle and connecting the two under the remaining tissue after the lateral release. The patella must be tensioned such that it does not result in the patella being pulled too far distally and also to prevent any further medial patellar instability. Tensioning should be performed while holding the patella in its normal position. The knee should be able to be flexed from 0 to 90 initially and checking this tension is important.
Rehabilitation for a lateral patellotibial ligament reconstruction involves active flexion and passive extension exercises from 0 to 90 degrees of knee flexion initially and avoiding any medial to lateral patellar glides in the initial 6 weeks. In addition, patients are kept non-weight-bearing or toe-touch weight-bearing for the first 6 weeks. After this initial time frame, they start the use of a stationary bike and work on further strengthening. Most patients can resume normal activities at about 5 to 6 months after the lateral patellotibial ligament reconstruction.