Applied Anatomy Study On Reconstructing The Medial Patellofemoral Ligament By Using The Adductor Magnus Tendon

Objective The aims of this study were to observe the morphological of the Adductor Magnus Tendon and the Medial Patellofemoral Ligament,and the adjacent relationship about the peripheral vascular nerve based on the anatomy of the medial region on 30 cadaveric knees.To evaluate the surgical feasibility and possible risks of reconstructing the Medial Patellofemoral Ligament(MPFL)by using the Adductor Magnus Tendon on two ways(with line anchors,silk suture),simulation surgery in the cadaver to explore the methods of the fixation techniques.After this method was used in the clinical,to evaluate the practicality of this surgical method,and how to improve the surgical method.Methods Anatomical characteristics were observated on 30 cadaveric knees about the Adductor Magnus Tendon,the Medial Patellofemoral Ligament morphology and peripheral vascular nerve adjacent relationship.The length of adductor magnus tenden,the width of adductor magnus tenden,the thickness of adductor magnus tenden,the length of MPFL,the distance from adductor tubercle to the MPFL femoral attachment,the distance from adductor tubercle to transitional part were measured,taked photos of the anatomical region,and surgical simulation operation were operated on the cadaver.Four patients with patellar dislocation were treated by using the Adductor Magnus Tendon to reconstruct the Medial Patellofemoral Ligamentin under the aid of arthroscope.Four patients were treated with double incision technique,the knees were fixed by gypsum after the operation and maked the quadriceps exercise.The practicality of this surgical method was evaluated with collecting the information by outpatient follow-up and telephone follow-up.Results After anatomy of the medial region on 30 cadaveric knees,we could see the adductor magnus tenden have two forms:(1)aponeurosis type;(2)conical type.The major tissues associated with the adductor magnus tenden include: the knee descending artery and its branches,saphenous nerve.We could see the MFPL 100% in the anatomy,the MPFL was located in the medial soft tissue structure of the knee(femoral medial condyle and adductor tubercle)to the medial patellar side of the shape,the process of walking more and more wide,the shape of the ligament,the MPFL was divided into two functional regions:the superior oblique bundle and the inferior straight bundle.The average data were measured by using the vernier caliper(accuracy of 0.01mm)repeated measurements after 3 times as follows:the lengthes of adductor magnus tenden(distance from the adductor tubercle to the adductor hiatus)were 105±14mm(77-129mm),the widths of adductor magnus tenden were 9±2mm(5-17mm),the thicknesses of adductor magnus tenden were 2±0.4mm(1-3mm),the lengthes of the medial patellofemoral ligament were 46±6mm(33-57mm),the distances from the adductor tubercle to the MPFL femoral insertion were 9±2mm(6-13mm),the distances from adductor tubercle to transitional part were 124±11mm(102-144mm).The operation of the MPFL was fixed in the medial margin of the patella with anchor or silk thread,the operative effect was satisfactory.There were no singnificant tissues in the medial area have been damaged,taked pictures to record the operation of the simulation data.Four patients had good incision healing after surgery,there were no signs of infection,they were followed up for 2-19 months after leaving hospital.The results were as follows: postoperative patients review of the knee patella axial X-ray showed patella in situ,anchor fixation in the position,all patients had no pain after 1 month,after removal of gypsum and encourage patients to exercise and walk,the knee function returned to normal in 2-3 months,no recurrence of postoperative patella dislocation.Lysholm score was significantly improved compared with preoperative knee.Conclusions To repair or reconstruct the MPFL was an important method for the treatment of patellar dislocation.It was still the key to the successful operation of the anatomical structure.In this study,the anatomy of the medial region of the knee,and simulated surgery,we thought that a About 55 mm graft fixed in the medial border of the patella for the reconstruction of the MPFL was feasible,in traoperative success to avoid the separation of adductor magnus tenden when the adjacent tissue(knee descending artery and its branches,saphenous nerve)damage,based on the consideration and avoidance of anatomical risk,the adductor magnus tendon as a reconstruction graft of the MPFL was a good choice.In the clinical practice of using the adductor magnus tenden transposition to reconstruct the medial patellofemoral ligament in the treatment of patellar dislocation,the knee function was restored after surgery operation,there were no obvious complications occurred,this surgical method was worthy of promotion in clinical.