The Docking Technique for Medial Patellofemoral Ligament Reconstruction

Patella instability is a disabling condition, particularly in young athletes, that limits participation in sports because of apprehension and pain. The instability is related to several factors, including malalignment, osseous, and soft-tissue deficiencies that allow the patella to translate laterally and ultimately dislocate. In patients with normal osseous anatomy and lower-extremity mechanical alignment, the instability is attributed to deficient soft-tissue structures. Biomechanical studies demonstrate the medial patellofemoral ligament as the primary soft-tissue restraint to lateral patellar translation. Medial patellofemoral ligament reconstruction with vastus medialis obliquus advancement is indicated in patients with medial soft-tissue deficiency and symptomatic instability. The technique uses a semitendinosus tendon that is fixed to the medial patella with a docking technique and to the femur with an interference screw at the location of greatest isometry. The vastus medialis obliquus muscle is advanced over the reconstructed tendon. Secure fixation enables accelerated rehabilitation. Early results have demonstrated high success rates.

Keywords: patella, instability, ligament, reconstruction, docking, interference