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Surgery Case series

Double tunnel technique for Medial Patellofemoral Total knee replacement in elderly patients with

Ligament Reconstruction distal femoral fracture

Follow up was done for 24-36 months
Total knee replacement for DFF in
Dr. Somasekhar Reddy Mean IKDC and Kujala score showed significant Dr.Mahesh Kulkarni elderly
improvement (p < 0.001) with no recorded recurrence A systematic review of primary TKR for DFF reported
Nallamilli of dislocation Joint Replacement Surgeon 13 studies with a total of 98 patients who underwent

Joint Replacement Clinic, Pune total knee replacement for the management of DFF. [2]
Sr. Consultant Orthopeadic & Joint Replacement Advantages of this technique
Overall results were encouraging, with most studies
Apollo Hospitals, Hyderabad Anatomic reconstruction [2] showing 90° - 135° of flexion to near full extension
Introduction after treatment. [2]
Not reliant on implants in the patella [1]
Distal femur fracture (DFF) accounts for 0-4% of all At follow-up, most of the patients achieved full
Introduction The double tunnel technique allows a larger ligament adult fractures and 3% of femoral fractures. [1] weight-bearing and were capable of walking on
diameter comprising a double thickness of the stairs. [2]
Rupture of medial patellofemoral (PF) ligament hamstring to be reconstructed. [1] Current surgical treatment options for DFF including
(MPFL) is evident in recurrent patellar dislocation intramedullary nailing, internal fixation, and Modular constrained implants were found
resulting in patellar instability. [1] It minimizes graft impingement without increasing external fixation, are complicated by prolonged appropriate for comminuted intra-articular
the risks of patellar fracture [1] immobility, malunion, and nonunion. [2] fractures, whereas extra-articular fractures were
Anatomic reconstruction of the MPFL has been sufficiently managed with unconstrained implants. [2]
shown to restore patellar stability in cases with Less hardware is used with minimal cost and fewer In elderly patients, the main surgical goals are to
normal lower-extremity alignment. [2] complications. [1] minimize operative time and reduce time to mobility Conclusion
which is challenging in cases of DFF. [2]
Surgical technique [1] Disadvantages Total knee arthroplasty for distal femoral fractures is
This article describes total knee replacement (TKR) a viable treatment option in elderly patients
Two parallel tunnels are formed with a 1 cm bridge Dual tunnels may lead to an increased risk of fracture as a treatment option for DFF in elderly patients.
covering most of the native MPFL patellar footprint. [2] It provides immediate full weight-bearing and a rapid
return to preoperative functional status.
An autologous graft (STG) is sutured together to be Tensioning can be difficult with the docking Mega knee prosthesis [1]
introduced from medial to lateral in one tunnel then technique [2]
passed from lateral to medial through the second A case series described the management of complex References
tunnel. Conclusion DFF using a mega knee-prosthesis in 4 patients with
an average age of 79.5 years. [1] 1. Ibrahim, S. A., Shohdy, E. M., Ramadan, S. A., Almisfer, A. K.,
It forms a loop on the lateral border of the patella Reconstruction of MPFL by this method provides a Abdulsattar, W. S., & Khairat, S. (2019). Medial Patellofemoral
through a single medial parapatellar incision. good clinical result in the treatment of PF instability A standard midline incision and medial para-patellar Ligament Reconstruction in Traumatic Patellar Dislocation
by using an autologous graft (STG). approach were utilized for all surgical procedures. [1] without Patellar Fixation. The Journal of Knee Surgery.
Clinical evidence [1] doi:10.1055/s-0039-1688841
References The implant used for all cases was the cemented
OSSTM Orthopaedic Salvage System (Zimmer
Prospective study of 45 patients with PF instability, 2. Chen F, Li R, Lall A, Schwechter EM. Primary Total Knee
rupture of MPFL and normal patellar tracking 1. Ibrahim, S. A., Shohdy, E. M., Ramadan, S. A., Almisfer, A. K., Biomet, Warsaw, Indiana, USA) [1]
Arthroplasty for Distal Femur Fractures: A Systematic Review of
Abdulsattar, W. S., & Khairat, S. (2019). Medial Patellofemoral
Indications, Implants, Techniques, and Results. Am J Orthop
Ligament Reconstruction in Traumatic Patellar Dislocation
MPFL reconstruction done without patellar fixation without Patellar Fixation. The Journal of Knee Surgery. Preoperative Postoperative Oxford WOMAC NRS ROM in (Belle Mead NJ). 2017;46(3):E163-E171.
Parker score
Parker score
degrees
score
score
hardware through two parallel trans-patellar tunnels doi:10.1055/s-0039-1688841
and one screw in the femoral tunnel Patient 1 8 7 36 17 1 0/110
Patient 2 9 7 39 8 0 0/135
2. Azimi H, Anakwenze O. Medial Patellofemoral Ligament
Reconstruction Using Dual Patella Docking Technique. Arthrosc Patient 3 8 5 25 37 1 0/100
Pre- and postoperative functional scores were Tech. 2017;6(6):e2093-e2100. Published 2017 Nov 6. Patient 4 9 8 41 7 0 0/125
recorded to assess clinical results
doi:10.1016/j.eats.2017.08.018 [Ref: 1]