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Check out my technique for MQTFL reconstruction. This can be used for kneecap dislocation or patients that undergo patellofemoral replacement.
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
This video, titled "Check out my technique for MQTFL reconstruction," details a Medial Quadriceps Tendon-Femoral Ligament (MQTFL) reconstruction. The surgeon performs this lesser-known stabilizing procedure alongside a patellofemoral joint replacement on a patient with a history of recurrent patellar dislocations and a large Tibial Tubercle-Trochlear Groove (TT-TG) distance.
The MQTFL reconstruction is highlighted as an excellent alternative to an MPFL reconstruction because it achieves equal stability without requiring any bone drilling into the patella, making it ideal for young patients with open growth plates or patients with existing patellar implants.
The procedural steps shown in the video include:
- Femoral Tunnel Preparation: The surgeon uses a combination of manual landmark palpation and fluoroscopic (X-ray) guidance to locate "Schöttle's point" on the femur. A guide pin is placed and checked with a small reamer to ensure the precise anatomical entry point.
- Isometry Testing: Before final reaming, two slits are made in the quadriceps tendon to trace the intended path of the MQTFL. The knee is put through a full range of motion (0 to 90 degrees) with a semitendinosus allograft to confirm excellent tracking and ligament tension (isometry) before final fixation.
- Femoral Fixation: The semitendinosus allograft is passed into the femoral tunnel and secured tightly using a PEEK interference screw.
- Quadriceps Tendon Fixation (Fulkerson Technique): Instead of drilling into the patella, the graft is passed directly through the quadriceps tendon, looped over, and pulled back on itself. With the knee tensioned at roughly 45 degrees of flexion to ensure there is no further risk of dislocation, the graft is stitched directly into the quadriceps tendon.
- Suturing and Trimming: The graft is securely bound to the tendon using high-strength suture tape applied via multiple half-hitches and figure-of-eight stitches. The excess bulk of the allograft tendon is trimmed away.
- Arthrotomy Closure: The joint capsule (arthrotomy) is closed deep to the reconstructed ligament. The surgeon notes this is vital to ensure the newly reconstructed ligament does not painfully rub against the patellofemoral joint implant.
