Concomitant Patellar Tendon Reconstruction With Hamstring Autografts and Medial Patellofemoral Ligament Reconstruction With Quadriceps Autograft in the Setting of Severe Patellar Tendinopathy With Recurrent Lateral Patellar Instability

Authors:

Evan P. Shoemaker, B.A., Luke V. Tollefson, B.S., Dustin R. Lee, M.D., Matthew T. Rasmussen, M.D., Riccardo Cristiani, M.D., Ph.D., and Robert F. LaPrade, M.D., Ph.D.

Abstract:

Chronic injuries to the extensor mechanism present unique challenges to physicians because of their complex nature and the need for a multifactorial treatment approach. When conservative treatment is unsuccessful in the setting of patellar tendinopathy, surgical intervention may be required to improve symptoms. For patients with concomitant lateral patellar instability, surgical treatment is also indicated to prevent future dislocations and worsening patellofemoral symptoms. Current literature presents numerous patellar tendon and medial patellofemoral ligament arthroscopic and open reconstruction techniques with varying short- and long-term outcomes. Known risk factors must be considered preoperatively when addressing patellofemoral pathology. The purpose of this Technical Note is to describe a technically challenging procedure to treat concomitant severe patellar tendinopathy with concurrent lateral patellar instability.

Technique video appears in the study from Arthroscopy Techniques. Video Credit: Evan P. Shoemaker, B.A., Luke V. Tollefson, B.S., Dustin R. Lee, M.D., Matthew T. Rasmussen, M.D., Riccardo Cristiani, M.D., Ph.D., and Robert F. LaPrade, M.D., Ph.D.

Injury to the extensor mechanism of the knee is common.1,2 Severe patellar tendinopathy results from the overuse and gradual degeneration of the patellar tendon fibers, frequently located posterior/posteromedially at the inferior pole of the patella and observed at greater rates in patients younger than 40 years of age, and severe cases may require surgical treatment.2,3 Primary lateral patellar dislocations have a relatively low incidence of recurrent instability, with recurrent dislocation observed near 17%.4 If re-dislocation occurs, there is an exponential increase (50%) for additional dislocations.1

Numerous surgical techniques are described for these conditions in isolation.2,5, 6, 7 In the setting of severe patellar tendinopathy, open or arthroscopic debridement and reconstruction of the patellar tendon with hamstring autografts are described.8 In the case of recurrent patellar instability, medial patellofemoral ligament (MPFL) reconstruction with quadriceps or hamstring autograft has been reported as having postoperative success. We describe a patellar tendon reconstruction with hamstring autografts and MPFL reconstruction with quadriceps tendon autograft in the setting of severe patellar tendinopathy with chronic recurrent patellofemoral instability.

You can download the study: Concomitant Patellar Tendon Reconstruction With Hamstring Autografts and Medial Patellofemoral Ligament Reconstruction With Quadriceps Autograft in the Setting of Severe Patellar Tendinopathy With Recurrent Lateral Patellar Instability

Robert LaPrade, MD PhD

Average rating:

27 reviews

Michael freimuth

Aug 1, 2021

by Michael freimuth on Robert LaPrade, MD PhD

So lucky

In 2007 i was playing soccer and as i planted my left foot the goalie kicked my left knee dislocating it 90° to the left. I was told i tore everything...mcl pcl lcl acl all tendons around my knee the minicus flipped over the knee cap tearing the patellar tendon and oh yeah i guess i broke my femur too. First surgeon i went to literally gave me 2 options.
1) he could remove part of my leg because he couldnt find a pulse in my foot
2) he would refer me to the expert.
Obviously i chose the second option. Upon meeting his team, my life changed. There was never any talk of removing my leg and immediately found a pulse in my foot. On top of that they asked if i was free the coming Wednesday to operate. Hearing reviews about the U of M and of dr laPrade i went ahead and let him try to help me. Best decision ever. Yes, it took a long time to recover. But as i was healing he would find ways to help me be able to see him. Even said my left knee was tighter than my right. I had to have my meniscus removed during my surgery and after 2 years i still didn't have arthritis. It is now 2021, yes thats 14 years after my injury havent seen or spoken to him in 12 years.what he doesn't know.....
I did manual labor the whole time grueling work, i snowboard....and i hit jumps, ice-skating and hockey are still fun and easy, i joined another soccer league and get this, im considered the fastest player....in the league! Im 36 now... took me 12 years to get on here just to say thank you..... feels like its to little and took to long compared to the gift he gave me. If nothing else, thank you!
Mike f

Sue Stanek

Jan 2, 2020

by Sue Stanek on Robert LaPrade, MD PhD

So glad I waited for the best

I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.
You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!
- From your 63 year old very appreciative patent ~

Nancy S Stevenson

Aug 14, 2019

by Nancy S Stevenson on Robert LaPrade, MD PhD

Right Knee Surgery After Auto Bicycle Accident

Dr. Robert F. LaPrade operated on my right knee in May of 2010. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. I can run, bike, & climb mountains. In fact 2 years ago I finished climbing the top 100 peaks in CO.

Submit your review
Name:
Email:
Website:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

Concomitant Patellar Tendon Reconstruction With Hamstring Autografts and Medial Patellofemoral Ligament Reconstruction With Quadriceps Autograft in the Setting of Severe Patellar Tendinopathy With Recurrent Lateral Patellar Instability

Authors:

Abstract:

Technique video appears in the study from Arthroscopy Techniques. Video Credit: Evan P. Shoemaker, B.A., Luke V. Tollefson, B.S., Dustin R. Lee, M.D., Matthew T. Rasmussen, M.D., Riccardo Cristiani, M.D., Ph.D., and Robert F. LaPrade, M.D., Ph.D.

About the Author: Robert LaPrade, MD