Summary

The use of intra operative ultrasound allows us to determine anatomic points in the repair of injured tissues in this way echo assisted surgery of the medial femoral patello ligament is a precise, minimally invasive technique with satisfactory functional and anatomic results and a return to the early sports activity.

Abstract

Introduction.
Echo-assisted surgery in reconstruction of the patellofemoral ligament is a minimally invasive technique that allows rehabilitation and anatomical restitution as well as the biomechanics of the knee joint.
Material and method.
Longitudinal, descriptive, prospective study.
21 patients, 16 women and 5 men (athletes).
Patients whose femoral anteversion and external tibial torsion are within normal parameters are taken into account.
Average age 22.6 years.
Right knee 14 patients, left knee 7 patients
Follow-up period January 2022-2024 (12 months).
All patients underwent diagnostic arthroscopy.
Using ultrasound, we determined the femoral insertion point of the new ligament, in addition to the insertion points at the medial and lateral side of the patella.
We proceeded to take the graft from the semimembranosus, preparing the graft.
We performed graft fixation on the lateral side of the patella upper segment using a POPLOK harpoon (CONMED) and HIFI #2 SUTURE (CONMED), after a 3 cm incision.
I pass the graft subcutaneously through the anterior face of the patella and proceed to fix the other segment using a POPLOK harpoon (CONMED) and HIFI#2 suture (CONMED) on the medial side of the lower segment of the patella, after a 3 cm incision.
We make a tunnel in the medial epicondyle of the femur, move the graft subcutaneously and proceed to fix it with an 8.0 by 30 mm screw (Matryx CONMED), after checking the patellofemoral alignment (using ultrasound and arthroscopy).

Results

The score on the Kujala assessment scale is 94.5 points on average.
2 patients presented residual pain located at the level of the external facet, they presented traumatic chondral injury secondary to patellar dislocation.
The return to sports activities was approximately 86.5 days.
In the postoperative radiological evaluation we used FICAT projections (30°) and we measured the lateral patellofemoral angle of Laurin, lateral deviation of Sasaki and Yagi and the angle of congruence of Merchant.
The intraclass correlation coefficient (ICC) was performed. In our study, for the three types of angles we obtained a high value of the ICC, in all of them the angle of congruence was good.

Conclusions

Echo-assisted surgery for reconstruction of the patellofemoral ligament is a good alternative, with less damage to soft tissues, faster recovery and fewer post-surgical complications.
The rehabilitation of the affected joint is practically immediate, which will allow us to adapt more quickly to daily life.
The use of intra operative ultrasound allows us to determine anatomic points in the repair of injured tissues in this way echo assisted surgery of the medial femoral patello ligament is a precise, minimally invasive technique with satisfactory functional and anatomic results and a return to the early sports activity.