Are the tubular grafts in the femoral tunnel in an anatomical or isometric position in the reconstruction of medial patellofemoral ligament?

Abstract

The study confirmed the major role of the MPFL in case of medial loading between 0° and 60°, by focusing on the importance of kinematically identifying the proper femoral point for fixation. While the study demonstrates the importance of kinematic determination of the proper femoral point of fixation, as the anatomical insertion remains difficult to identify. Even in dissected cadavers, the authors recorded a slightly anterior placement than native MPFL. After reconstruction, patellar stability in terms of lateral translation and tilt was similar to the intact MPFL, but patellar kinematics were not optimal with the use of a smaller and tubular graft than the native wider and fan-shaped MPFL.

The Efficacy of Medial Patellofemoral Ligament Reconstruction Combined with Tibial Tuberosity Transfer in the Treatment of Patellofemoral Instability

“…The terms 'objective patellar instability' and 'episodic patellar dislocation' have been coined 18 19) and this terminology not only reflects the broad spectrum nature of the condition but also gives rise to a better understanding in the variation of indications for the different surgical options. Many questions remain unanswered: on whether a wide fan shaped ligament replaced by a tighter tubular shaped graft is the principal solution to patellar instability 20 21) ; and whether a tighter medial constraint following MPFL surgery is a desired side effect to compensate for patellofemoral malalignment conditions 21) ? In addition, there is a clear lack of consensus on the indications for adding distal bony realignment procedure to MPFL reconstruction.…”

Relationship between bony tunnel and knee function in patients after patellar dislocation triple surgeries—a CT-based study

“…Ntagiopoulos et al . reported that an anteriorly placed graft always resulted in a greater laterally directed load for translation during extension and a lower load during flexion than the original MPFL, vice versa25. Tateishi et al .…”

Anatomic Reconstruction of the Medial Patellofemoral Ligament Using the Fascia Lata as an Autograft

“…Another explanation for these complications is the higher stiffness and varying diameter of the semitendinosus or gracilis tendons compared with the fascia lata. 14 , 37 , 38 Nevertheless, if one is using the presented technique, care must also be taken to ensure the correct tension of the grafts after their fixation with the interference screw. The reason lies in the possibility of an accidental over-tensioning of the graft during the insertion of the implant.…”