A Magnetic Resonance Imaging Study of the Significance of the Distal Femoral Physis During Medial Patellofemoral Ligament Reconstruction

Greenrod, William; Cox, James F.; Astori, Ivan; Baulch, Justin; Williams, John L.

doi:10.1177/2325967113502638

Cited by 13 publications

(25 citation statements)

References 12 publications

(20 reference statements)

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“…Ensuring physeal safety during MPFL reconstruction is critical in the skeletally immature population, as the standard adult surgical technique of using screw fixation in the distal femur has been shown to frequently disturb the medial distal femoral physis. 5 An understanding of the close proximity of the MPFL origin to the medial distal femoral physis is important when considering screw placement and trajectory, as placement distal to the physis with a distal oblique trajectory has been shown to safely avoid physeal and joint penetration as compared with parallel screw placement. 5 Determining a safe and anatomic starting point is critical during preoperative planning for MPFL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Prior cadaveric and radiographic studies 1,5,8,13,20–22 have shown anatomic variation in the distance between the femoral insertion of the MPFL and distal femoral physis, with the distance generally being within millimeters of the physis. Other factors, such as age and sex, have also been suggested to influence this distance in patients with open physes.…”

mentioning

confidence: 99%

“…Other factors, such as age and sex, have also been suggested to influence this distance in patients with open physes. 1,5,21 Magnetic resonance imaging (MRI) is normally obtained preoperatively after a patellar instability event to evaluate for concomitant injuries, including osteochondral fractures and/or loose bodies. MRI is a preferred imaging modality in the skeletally immature population given its lack of ionizing radiation.…”

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confidence: 99%

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A Simple Method of Measuring the Distance From the Schöttle Point to the Medial Distal Femoral Physis With MRI

Bishop

Black

Nguyen

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Medial patellofemoral ligament (MPFL) reconstruction is the treatment of choice for recurrent patellar instability in the skeletally immature patient. Avoiding the open physes during anatomic MPFL reconstruction is a challenge in this population. Purpose: To describe a novel method using magnetic resonance imaging (MRI) to determine the distance from the Schöttle point to the medial distal femoral physis among skeletally immature individuals with patellar instability. Study Design: Descriptive laboratory study. Methods: Preoperative MRI scans were analyzed from 34 patients with open distal femoral physes and lateral patellar instability. With the multiplanar reconstruction mode on a picture archiving and communication system (PACS), the location of the Schöttle point was determined according to previously reported distances from the posterior femoral cortical line and the posterior origin of the medial femoral condyle. This location was then extrapolated to the most medial sagittal slice on MRI showing the medial distal femoral physis. The distance was measured from this point to the most distal aspect of the physis. Results: The mean age of the study cohort was 13.6 years (range, 10.6-15.7 years); there were 13 males and 21 females. The mean distance from the medial distal femoral physis to the Schöttle point was 7.27 ± 1.78 mm. The Schöttle point was distal to the medial distal femoral physis in all cases. There was no significant correlation between age and mean distance in either the overall study population ( r = 0.046, P = .798) or when stratified by sex (females, P = .629; males, P = .089). The distance between the Schöttle point and the medial distal femoral physis was shorter for females than for males (6.51 vs 7.71 mm, P = .043). After adjustment for age, females on average were 1.31 mm closer to the Schöttle point than were males ( B = –1.31, P = .041). Conclusion: This technique can be used to determine the distance between the medial distal femoral physis and the Schöttle point. The Schöttle point was distal to the physis in all patients, and it was closer to the physis in skeletally immature females compared with age-matched males. Clinical Relevance: The long-term repercussions of improperly placed MPFL reconstruction include recurrent patellar instability, increased patellofemoral contact pressures and overtensioning of the ligament, and possibly patellofemoral arthritis. The current technique can be used preoperatively to determine the appropriate safe distance for drilling a socket distal to the physis.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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A Simple Method of Measuring the Distance From the Schöttle Point to the Medial Distal Femoral Physis With MRI

Bishop

Black

Nguyen

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…For pediatric patients, there has been a great deal of investigation into the relationship of the MPFC to the distal femoral physis. There has been wide variability in findings, with the average origin of the MPFC occurring 4.7-10 mm distal to the physis [7,8]. The superior-most fibers of the MPFC origin commonly overlie the physis [7,8].…”

Section: Anatomy and Functionmentioning

confidence: 99%

“…There has been wide variability in findings, with the average origin of the MPFC occurring 4.7-10 mm distal to the physis [7,8]. The superior-most fibers of the MPFC origin commonly overlie the physis [7,8]. The origin may migrate closer to the physis in adolescence [8].…”

Section: Anatomy and Functionmentioning

confidence: 99%

The medial patellofemoral complex

Loeb

Tanaka

2018

Curr Rev Musculoskelet Med

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Recent advances in our understanding of MPFC anatomy have found that there are fibers that insert onto the deep quadriceps tendon as well as the patella, thus earning the name "medial patellofemoral complex" to allow for the variability in its anatomy. In MPFC reconstruction, anatomic origin and insertion points and appropriate graft length are critical to prevent overconstraint of the patellofemoral joint. The MPFC is a crucial soft tissue checkrein to lateral patellar translation, and its repair or reconstruction results in good restoration of patellofemoral stability. As our understanding of MPFC anatomy evolves, further studies are needed to apply its relevance in kinematics and surgical applications to its role in maintaining patellar stability.

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Anterior and distal tunnel orientation for anatomic reconstruction of the medial patellofemoral ligament is safer in patients with open growth plates

Irarrázaval

Besa

Fernández

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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PurposeIn patients with open growth plates, the direction of tunneling that avoids distal femoral physis (DFP) damage in anatomic reconstructions of the medial patellofemoral ligament (MPFL) has been a topic of discussion. The objective of this study was to determine the ideal orientation for anatomic reconstructions of MPFL tunneling that minimized DFP damage while avoiding breaching the intercondylar notch. Methods Eighty magnetic resonance images of patients aged 10 through 17 were obtained, randomly sampled from the institutional database. A de novo software was developed to obtain 3D models of the distal femur and DFP. In each model, the anatomical insertion point of the MPFL was determined as deined by Stephen. A 20-mm-depth drilling was simulated, starting from the insertion point at every possible angle within a 90° cone using 5-, 6-and 7-mm drills. Physeal damage for each pair of angles and each drill size was determined. Damage was expressed as a percentage of total physis volume. Statistical analysis was conducted using Student's t test and one-way ANOVA. Results Maximum physeal damage (5.35% [4.47-6.24]) was obtained with the 7-mm drill when drilling 3° cephalic and 15° posterior from insertion without diferences between sexes (n.s.). Minimal physeal damage (0.22% [0.07-0.37]) was obtained using the 5-mm drill aimed 45° distal and 0° anteroposterior, not afected by sex (n.s.). Considering intra-articular drilling avoidance, the safest zone was obtained when aiming 30°-40° distal and 5°-35° anterior, regardless of sex. Conclusion Ideal femoral tunnel orientation, avoiding physeal damage and breaching of the intercondylar notch, was obtained when aiming 30°-40° distal and 5°-35° anterior, regardless of sex. This area is a safe zone that allows anatomic MPFL reconstruction of patients with an open physis.

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A Magnetic Resonance Imaging Study of the Significance of the Distal Femoral Physis During Medial Patellofemoral Ligament Reconstruction

Cited by 13 publications

References 12 publications

A Simple Method of Measuring the Distance From the Schöttle Point to the Medial Distal Femoral Physis With MRI

A Simple Method of Measuring the Distance From the Schöttle Point to the Medial Distal Femoral Physis With MRI

The medial patellofemoral complex

Anterior and distal tunnel orientation for anatomic reconstruction of the medial patellofemoral ligament is safer in patients with open growth plates

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