3D Computed Tomography Evaluation of Morphological Changes in the Femoral Tunnel After Medial Patellofemoral Ligament Reconstruction With Hamstring Tendon Graft for Recurrent Patellar Dislocation

Kita, Keisuke; Tanaka, Yoshinari; Toritsuka, Yukiyoshi; Amano, Hiroshi; Uchida, Ryohei; Shiozaki, Yoshiki; Takao, Rikio; Horibe, Shuji

doi:10.1177/0363546517690348

Cited by 18 publications

(38 citation statements)

References 38 publications

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“…The analysis focused on relating patellar tracking to anatomy during continuous dynamic motion, without using loading conditions that cause patellar instability in the pre-operative or post-operative conditions. The simulated graft attachments and properties do not account for graft elongation or tunnel widening [39] that can occur post-operatively.…”

Section: Discussionmentioning

confidence: 99%

“…The resting length of the graft was set with the patella displaced 10 mm laterally from the deepest point of the trochlear groove (range of patellar width: 36 to 43.5 mm). The resting length was also set with the patella displaced by 5 mm to represent a more restrictive surgical approach [3, 6, 39]. A dual strand gracilis tendon graft for MPFL reconstruction was represented by two springs with a total stiffness of 20 N/mm [40].…”

Section: Methodsmentioning

confidence: 99%

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Dynamic tracking influenced by anatomy following medial patellofemoral ligament reconstruction: Computational simulation

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Dynamic tracking influenced by anatomy following medial patellofemoral ligament reconstruction: Computational simulation

et al. 2018

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“…The assumed properties emphasize the importance of the updated accuracy assessment. Graft attachments and properties do not account for graft elongation or tunnel widening [21] that can occur post-operatively. The data also specifically applies to tensioning a hamstrings tendon graft at 30° of knee flexion, while some studies described tensioning at higher or lower flexion angles [9, 15, 26, 44] and other graft options, such as the quadriceps tendon [17, 23], are available.…”

Section: Discussionmentioning

confidence: 99%

Allowing one quadrant of patellar lateral translation during medial patellofemoral ligament reconstruction successfully limits maltracking without overconstraining the patella

Elias

Jones

Lalonde

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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“…The final challenge is preventing femoral tunnel graft movement. Kita et al 17 demonstrated that the femoral tunnel aperture enlarged and migrated anteriorly with time after MPFLR. This adaptive phenomenon can be explained by the graft constraint induced by patellar tracking.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Predictors of Functional Outcome After Isolated Medial Patellofemoral Ligament Reconstruction at Midterm Follow-up

et al. 2019

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Background: Isolated medial patellofemoral ligament reconstruction (iMPFLR) is increasingly used for the surgical treatment of recurrent patellofemoral instability. Purpose: The purpose of this study was to identify the clinical and radiological predictors that can significantly influence the functional outcomes after an iMPFLR. Study Design: Case series; Level of evidence, 4. Methods: A total of 107 patients (112 ligament reconstructions) who underwent iMPFLR were evaluated with a mean ± SD follow-up of 59 ± 33 months (range, 12-123 months). Functional International Knee Documentation Committee (IKDC) and Kujala scores were assessed preoperatively and every 12 months. Radiological assessment of patellar height and tilt (Laurin angle, Merchant angle, Maldague classification) and computed tomography (CT) scan measurement of patellar tilt (contracted and relaxed quadriceps) and tibial tubercle–trochlear groove distance were performed preoperatively and at 6 months. Femoral tunnel position was assessed following the criteria formulated by Schöttle. The amount of femoral tunnel widening was measured by means of 3-dimensional CT scan at 6 months. Predictors were determined from univariate and multivariate regression analyses integrating clinical and radiological criteria pre- and postoperatively. The dependent variable was defined as the difference between pre- and postoperative scores. Results: Between pre- and postoperative measurement at last follow-up, a significant improvement for IKDC and Kujala functional scores was observed (Kujala: 57 ± 11.3 to 87 ± 12.9, P < .001; IKDC: 47.8 ± 13.1 to 79 ± 15.8, P < .001). Demographics (age, body mass index, sex), dislocation characteristics (number of dislocations, time between first dislocation and surgery, age at first dislocation, mechanism of first dislocation, knee side), clinical data (frontal limb alignment, hyperlaxity, recurvatum, pre- and postoperative range of motion), and complications (quadriceps atrophy, complex regional pain syndrome) did not influence functional scores. The predictors of lower improvement in functional scores included small correction of the patellar tilt reported on the CT scan measurement, malpositioning of the femoral tunnel, and a widening of this tunnel near the medial cortex. Malpositioning of the femoral tunnel was correlated with tunnel widening, and patients with anterior and proximal malpositioning experienced stiffness in flexion. Conclusion: Overall, iMPFLR demonstrated good outcomes. Predictors influencing the functional results were identified. Less improvement in clinical outcome was reported for patients with a high preoperative patellar tilt and only a small correction in tilt and for those who had femoral tunnel malpositioning, which was correlated with tunnel widening.

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3D Computed Tomography Evaluation of Morphological Changes in the Femoral Tunnel After Medial Patellofemoral Ligament Reconstruction With Hamstring Tendon Graft for Recurrent Patellar Dislocation

Abstract: The CSA of the femoral tunnel aperture enlarged, and the tunnel aperture migrated anteriorly with time after MPFL reconstruction. Risk factors for patellar dislocation other than patella alta did not influence morphological changes of the femoral tunnel.

Cited by 18 publications

References 38 publications

Dynamic tracking influenced by anatomy following medial patellofemoral ligament reconstruction: Computational simulation

Dynamic tracking influenced by anatomy following medial patellofemoral ligament reconstruction: Computational simulation

Allowing one quadrant of patellar lateral translation during medial patellofemoral ligament reconstruction successfully limits maltracking without overconstraining the patella

Clinical and Radiological Predictors of Functional Outcome After Isolated Medial Patellofemoral Ligament Reconstruction at Midterm Follow-up

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