Combined MPFL reconstruction and tibial tuberosity transfer avoid focal patella overload in the setting of elevated TT–TG distances

Berton, Alessandra; Salvatore, Giuseppe; Nazarian, Ara; Longo, Umile Giuseppe; Orsi, Alexander; Egan, Jonathan; Ramappa, Arun J.; DeAngelis, Joseph P.; Denaro, Vincenzo

doi:10.1007/s00167-022-07056-6

Cited by 9 publications

(6 citation statements)

References 61 publications

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“…16 Both treatment options coexist and potentially can be combined for recurrent patellar dislocation. Berton et al 11 recently demonstrated that combined MPFL reconstruction and TTO avoid focal patellar overload in the setting of elevated TT-TG distances. However, only a few studies have analyzed the results of MPFL reconstruction with and without TTO.…”

Section: Discussionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction Using Allografts in Skeletally Immature Patients

et al. 2023

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Background: Patellar instability has the highest incidence in adolescents aged between 14 and 18 years. The unique relationship between the medial patellofemoral ligament (MPFL) and the distal femoral physis in skeletally immature patients warrants precisely positioned MPFL graft insertion. A paucity of data are available evaluating the results of MPFL reconstruction using allograft tendon before skeletal maturity. Purposes: (1) To assess the results of MPFL reconstruction using allograft tendon in skeletally immature patients by analyzing redislocation and reoperation rates, radiological outcomes, and patient-reported outcomes and (2) to determine whether epidemiological, intraoperative, or radiographic factors influence recurrent instability and clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were retrospectively analyzed for 69 skeletally immature patients who experienced a first-time or recurrent lateral patellar dislocation and were treated with anatomic MPFL reconstruction. Inclusion criteria were MPFL reconstruction using allograft and the availability of preoperative magnetic resonance imaging scans in the presence of open or partially open physes. Patients with <2 years of follow-up and patients with previous surgeries on the same knee were excluded from the study. Preoperative radiographic imaging was reviewed and analyzed. Trochlear dysplasia, tibial tubercle–trochlear groove distance, and patellar height were evaluated. Descriptive data, concomitant injuries, surgical procedure details, complications, and postoperative history were assessed via review of medical records and patient charts. Validated patient-reported and surgeon-measured outcomes were collected pre- and postoperatively, including Kujala score, Lysholm score, and Tegner activity score. Return-to-sports rate was assessed. The influence of epidemiological, intraoperative, and radiographic parameters on the redislocation rates and clinical outcomes was assessed using a multiple linear regression model. Results: A total of 79 physeal-sparing MPFL reconstructions (69 patients) met the inclusion criteria. The mean age of the patient cohort was 14.7 ± 1.8 years (range, 8.5-16.9 years). Within the mean follow-up time of 37.9 ± 12.1 months (range, 24-85 months after surgery, there were 12 patients with clinical failures resulting in reoperation. Eleven patients experienced a redislocation of the patella, and 1 patient sustained a transverse noncontact patellar fracture 6 months after index surgery that required operative fixation. No injuries to the distal femoral physes were clinically observed. At the final follow-up, patients had a mean Lysholm score (1-100) of 96.5 ± 6.7, a mean Kujala score (1-100) of 96.5 ± 7.4, and a mean Tegner Activity Scale score (1-10) of 4.9 ± 1.3. Patellar height and trochlear dysplasia did not influence redislocation or clinical scores. In total, 57 of the 63 patients (90.5%) who were engaged in sports before injury returned to the same or higher level of competition. In a subgroup analysis of patients who underwent isolated MPFL reconstruction (n = 44) without concomitant procedures, 9 patients (20.5%) experienced failure and had a redislocation. A univariate analysis of hazards for failure based on patient-specific variables was carried out. A body mass index ≥30 conveyed a hazard ratio of 2.51 (95% CI, 0.63-10.1; P = .19), and the tibial tubercle-trochlear groove distance by increments of 1 mm was associated with a hazard ratio of 2.02 (95% CI, 0.51-8.11; P = .32). Conclusion: Physeal-sparing anatomic reconstruction of the MPFL using an allograft tendon in skeletally immature patients was a safe and effective treatment for patellar instability, regardless of patellar height and trochlear dysplasia. Failure rates decreased when the MPFL reconstruction was performed concomitantly with a tibial tubercle osteotomy.

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Section: Discussionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction Using Allografts in Skeletally Immature Patients

et al. 2023

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“…58 Some scholars have also modeled the muscle as a two-dimensional fiberreinforced structure containing membrane and spring elements. 59,60 Tendons are similar in structure and function to ligaments. Tendons can be modeled with spring elements and hyperelastic material models, with the spring elements being widely used.…”

Section: Muscle and Tendonmentioning

confidence: 99%

“…simplified the muscle model and used spring elements to simulate the muscle 58 . Some scholars have also modeled the muscle as a two‐dimensional fiber‐reinforced structure containing membrane and spring elements 59,60 . Tendons are similar in structure and function to ligaments.…”

Section: Model Constructionmentioning

confidence: 99%

“…Many finite element studies have also been conducted on medial patellofemoral ligament (MPFL) injuries. MPFL reconstruction alone was sufficient to restore the kinematic function of the knee, and tibial tuberosity displacement was necessary when the distance between the tibial tuberosity and the talocrural groove was too large 60 . It has been suggested that tibial tuberosity displacement combined with lateral retinaculum release could significantly reduce the contact area and stress in the patellofemoral joint, but there was a risk of lateral patellofemoral instability 79 .…”

Section: Application and Characteristicsmentioning

confidence: 99%

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Model Properties and Clinical Application in the Finite Element Analysis of Knee Joint: A Review

Yan,

Liang,

Zhao

et al. 2024

Orthopaedic Surgery

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The knee is the most complex joint in the human body, including bony structures like the femur, tibia, fibula, and patella, and soft tissues like menisci, ligaments, muscles, and tendons. Complex anatomical structures of the knee joint make it difficult to conduct precise biomechanical research and explore the mechanism of movement and injury. The finite element model (FEM), as an important engineering analysis technique, has been widely used in many fields of bioengineering research. The FEM has advantages in the biomechanical analysis of objects with complex structures. Researchers can use this technology to construct a human knee joint model and perform biomechanical analysis on it. At the same time, finite element analysis can effectively evaluate variables such as stress, strain, displacement, and rotation, helping to predict injury mechanisms and optimize surgical techniques, which make up for the shortcomings of traditional biomechanics experimental research. However, few papers introduce what material properties should be selected for each anatomic structure of knee FEM to meet different research purposes. Based on previous finite element studies of the knee joint, this paper summarizes various modeling strategies and applications, serving as a reference for constructing knee joint models and research design.

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“…Tibial tuberosity medialization tends to have a greater influence on the patellofemoral contact pressure distribution than MPFL reconstruction. 22 , 26 Tibial tuberosity medialization tends to shift pressure medially, 20 , 22 which is a concern for patients with medial cartilage lesions due to patellar dislocation. 27 …”

Section: Introductionmentioning

confidence: 99%

Adding Tibial Tuberosity Medialization to Medial Patellofemoral Ligament Reconstruction Reduces Lateral Patellar Maltracking During Multidirectional Motion in a Computational Simulation Model

Elias

Cosgarea

Tanaka

2023

Arthroscopy, Sports Medicine, and Rehabilitation

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Combined MPFL reconstruction and tibial tuberosity transfer avoid focal patella overload in the setting of elevated TT–TG distances

Cited by 9 publications

References 61 publications

Medial Patellofemoral Ligament Reconstruction Using Allografts in Skeletally Immature Patients

Medial Patellofemoral Ligament Reconstruction Using Allografts in Skeletally Immature Patients

Model Properties and Clinical Application in the Finite Element Analysis of Knee Joint: A Review

Adding Tibial Tuberosity Medialization to Medial Patellofemoral Ligament Reconstruction Reduces Lateral Patellar Maltracking During Multidirectional Motion in a Computational Simulation Model

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