Biomechanical tensile strength analysis for medial patellofemoral ligament reconstruction

Joyner, Patrick W.; Bruce, Jeremy; Roth, Travis S.; Mills, Frederic Baker; Winnier, Scott; Hess, Ryan; Wilcox, Luke; Mates, Aaron; Frerichs, Tim; Andrews, James R.; Roth, Charles

doi:10.1016/j.knee.2017.04.013

Cited by 24 publications

(32 citation statements)

References 35 publications

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“…18 The present study suggests that SA femoral fixation is biomechanically similar to IS fixation in terms of load to failure. These findings differ from those of Joyner et al, 14 who examined the tensile strength of 5 reconstruction techniques and concluded that suspensory cortical fixation to the femur with IS fixation to the patella was the strongest configuration and suspensory cortical femoral fixation with SA patellar fixation was the weakest. In contrast to our reconstruction method, Joyner et al used a gracilis allograft with suspensory cortical fixation on the femoral side and an unspecified size of bioabsorbable SA on the patellar side.…”

Section: Discussioncontrasting

confidence: 89%

“…Six fresh-frozen matched pairs of male cadaveric knees (mean age, 52.8 years [range, 44-62 years]) were obtained from donations to the state anatomy board and thawed for 24 hours. A priori power analysis was conducted based on the results of the study by Joyner et al, 14 who previously reported the mean load-to-failure values for IS (261.6 ± 67.8 N, 267.1 ± 88.5 N, 191.2 ± 82.7 N) and SA (120 ± 21.6 N) graft fixation in MPFL reconstruction. It was determined that 5 specimens per group would provide a power of 80% to detect a difference (a < .05) of 119.9 N in the mean load to failure.…”

Section: Methodsmentioning

confidence: 99%

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Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study

Gould

Delaney

Parks

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Femoral-sided graft fixation in medial patellofemoral ligament (MPFL) reconstruction is commonly performed using an interference screw (IS). However, the IS method is associated with several clinical disadvantages that may be ameliorated by the use of suture anchors (SAs) for femoral fixation. Purpose: To compare the load to failure and stiffness of SAs versus an IS for the femoral fixation of a semitendinosus autograft in MPFL reconstruction. Study Design: Controlled laboratory study. Methods: Based on a priori power analysis, a total of 6 matched pairs of cadaveric knees were included. Specimens in each pair were randomly assigned to receive either SA or IS fixation. After an appropriate reconstruction procedure, the looped end of the MPFL graft was pulled laterally at a rate of 6 mm/s until construct failure. The best-fit slope of the load-displacement curve was then used to calculate the stiffness (N/mm) in a post hoc fashion. A paired t test was used to compare the mean load to failure and the mean stiffness between groups. Results: No significant difference in load to failure was observed between the IS and the SA fixation groups (294.0 ± 61.1 vs 250.0 ± 55.9; P = .352), although the mean stiffness was significantly higher in IS specimens (34.5 ± 9.6 vs 14.7 ± 1.2; P = .004). All IS reconstructions failed by graft pullout from the femoral tunnel, whereas 5 of the 6 SA reconstructions failed by anchor pullout. Conclusion: In this biomechanical study using a cadaveric model of MPFL reconstruction, SA femoral fixation was not significantly different from IS fixation in terms of load to failure. The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL. Clinical Relevance: These results suggest that SAs are a biomechanically viable alternative for femoral-sided graft fixation in MPFL reconstruction.

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Section: Discussioncontrasting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study

Gould

Delaney

Parks

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…12,25,30 In this setting, comparative studies have demonstrated appropriate strength and equivalent clinical outcomes using small anchors for fixation. 11,12,17,27 With this evidence, anchor-based graft fixation at the patella has gained popularity, while tenodesis screw fixation at the femur remains standard of care.…”

Section: Discussionmentioning

confidence: 99%

Anchor-Based Femoral Fixation for Physeal-Sparing Medial Patellofemoral Ligament Reconstruction: A Time-Zero Biomechanical Comparison With Tenodesis Screw Fixation

2020

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Background: Open physes and trochlear/notch geometries in pediatric patients limit the safe corridor for femoral interference screw graft fixation during medial patellofemoral ligament (MPFL) reconstruction. Accordingly, interest is increasing in anchor-based fixation, but biomechanical validation is deficient. Purpose: To compare anchor-based and tenodesis screw femoral fixation of MPFL grafts in a time-zero biomechanical model. Study Design: Controlled laboratory study. Methods: Twenty-seven fresh-frozen porcine distal femurs were potted for testing in an electromechanical load frame, while bovine tendons were used for MPFL grafts. Reconstructions were performed with 1 of 3 femoral fixation strategies: 4.5-mm biocomposite double-loaded threaded anchor (DLA group), 3.9-mm biocomposite knotless threaded anchor (KA group), or traditional 7 × 23–mm biocomposite tenodesis screw (TS group). For testing, femoral specimens were oriented and secured in the mechanical testing apparatus such that actuator tensile pull re-created the normal MPFL trajectory. Specimens underwent 10 cycles of 5- to 15-N loading at 1-Hz preconditioning, followed by 1000 cycles of 10- to 50 N-loading at 1 Hz. After cyclic loading, all specimens were loaded to failure at 305 mm/min. The average cyclic construct stiffness, displacement, and load-to-failure data between the 3 groups were compared using analysis of variance (ANOVA) with the significance level set at P < .05. Results: Average cyclic construct stiffnesses were comparable across groups per repeated-measures ANOVA analysis: 68.3 ± 6.3, 71.4 ± 6.4, and 74.3 ± 7.9 N/mm for TS, DLA, and KA groups, respectively (at cycle 1000). Average construct displacements at cycles 100 and 1000 were significantly less in the anchor versus tenodesis screw groups per ANOVA and Tukey post hoc analysis: 7.7 ± 4.2 mm for the TS group versus 3.7 ± 0.4 and 4.3 ± 0.6 mm for the DLA and KA groups, respectively (at cycle 1000). There was no significant difference in ultimate failure loads between the anchor and tenodesis screw groups, but 3 of 9 TS constructs failed at loads below the average failure load of the native MPFL. Conclusion: Compared with the tenodesis group, anchor-based fixation produced constructs with equivalent cyclic stiffnesses, improved load-displacement characteristics, and had less failure load variability in the porcine cadaveric model. Clinical Relevance: Femoral fixation of the MPFL graft with a single anchor (4.5 or 3.9 mm threaded) is a viable alternative to traditional tenodesis screw fixation.

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“…The majority of patellar dislocations are lateral (24,25). The MPFL is the most important ligament in terms of medial patellar strength (50-60% of all the strength that is imparted) (26)(27)(28). The MPFL maintains the patellar trajectory and minimizes dislocation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of recurrent patellar dislocation via knee arthroscopy combined with C‑arm fluoroscopy and reconstruction of the medial patellofemoral ligament

Wang

et al. 2018

Exp Ther Med

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Recurrent patellar dislocations were treated via knee arthroscopy combined with C-arm fluoroscopy, and reconstruction of the medial patellofemoral ligaments. Between October 2013 and March 2017, 52 cases of recurrent patellar dislocation [27 males and 25 females; age, 16-47 years (mean, 21.90 years)] were treated. Arthroscopic exploration was performed and patellofemoral joint cartilage injuries were repaired. It was subsequently determined whether it was necessary to release the lateral patellofemoral support belt. Pre-operative measurements were used to decide whether tibial tubercle osteotomy was required. Medial patellofemoral ligaments were reconstructed using autologous semitendinosus tendons. Smith and Nephew model 3.5 line anchors were used to double-anchor the medial patellofemoral margin. On the femoral side, the medial patellofemoral ligament was fixed using 7-cm, absorbable, interfacial compression screws. All cases were followed for 1-40 months (average, 21 months). The Q angle, tibial tuberosity trochlear groove distance, Insall-Salvati index, patellofemoral angle, lateral patellofemoral angle and lateral shift were evaluated on X-Ray images using the picture archiving and communication system. Subjective International Knee Documentation Committee (IKDC) knee joint functional scores and Lysholm scores were recorded. Post-operative fear was absent, and no patellar re-dislocation or re-fracture was noted during follow-up. At the end of follow-up, the patellofemoral angle (0.22±4.23°), lateral patellofemoral angle (3.44±1.30°), and lateral shift (0.36+0.14°) differed significantly from the pre-operative values (all, P<0.05). Furthermore, IKDC and Lysholm scores (87.84+3.74 and 87.48+3.35, respectively) differed significantly from the pre-operative values (both, P<0.05). These findings suggest that, in the short term, recurrent patellar dislocation treatment via knee arthroscopy combined with C-arm fluoroscopy and reconstruction of the medial patellofemoral ligament was effective.

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Biomechanical tensile strength analysis for medial patellofemoral ligament reconstruction

Cited by 24 publications

References 35 publications

Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study

Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study

Anchor-Based Femoral Fixation for Physeal-Sparing Medial Patellofemoral Ligament Reconstruction: A Time-Zero Biomechanical Comparison With Tenodesis Screw Fixation

Treatment of recurrent patellar dislocation via knee arthroscopy combined with C‑arm fluoroscopy and reconstruction of the medial patellofemoral ligament

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