Combined Reconstruction of the Medial Patellofemoral Ligament and Medial Quadriceps Tendon–Femoral Ligament

Temponi, Eduardo Frois; Saithna, Adnan; Gonçalves, Matheus Braga Jacques; Soares, Luiz Fernando Machado; Carvalho, Rafael Baroni; Júnior, Lúcio Honório de Carvalho

doi:10.1016/j.eats.2020.09.026

Cited by 10 publications

(2 citation statements)

References 11 publications

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“…Similarly, surgeons have performed combined MPFL/MQTFL-R with good results. 22,26 Only recently have researchers begun to assess the biomechanical differences of these procedures. 7,21 Kang et al 10 proposed the idea of ''functional bundles'' in the MPFC, where the proximal MQTFL fibers play a dynamic role in the first 20°to 30°of knee flexion, pulling the patella medially, whereas the distal MPFL fibers serve as a static constraint.…”

Section: Discussionmentioning

confidence: 99%

“…Other investigators have proposed a hybrid approach using a double limb graft to reconstruct both the MPFL and the MQTFL to replicate the native anatomic features of the medial patellofemoral complex (MPFC) more closely and perhaps improve redislocation rates. 13,20,22,26,28 Similarly, the long-term clinical efficacy of these techniques remains to be seen. Two recent cadaveric models were used to evaluate the effect of these various techniques on contact pressures, patellar lateralization, and patellar tilt.…”

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confidence: 99%

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Effect of Medial Patellofemoral Complex Reconstruction Technique on Patellofemoral Contact Pressure, Contact Area, and Kinematics

White,

James,

Jahandar

et al. 2024

Am J Sports Med

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Background: Medial patellofemoral ligament (MPFL) reconstruction is considered by many to be the gold standard to treat lateral patellar instability; however, some investigators have reported good clinical results after isolated medial quadriceps tendon–femoral ligament (MQTFL) reconstruction or a combined MPFL/MQTFL reconstruction. A handful of studies have preliminarily investigated the biomechanical consequences of these various medial patellar stabilizing procedures. Despite this, no existing study has included multiple medial patellofemoral complex (MPFC) reconstructions and assessment of lateral patellar translation at distinct flexion angles. Hypothesis: Combined MPFL/MQTFL reconstruction would restore patellofemoral contact areas, forces, and kinematics closest to the native state compared with isolated reconstruction of the MPFL or MQTFL alone. Study Design: Controlled laboratory study. Methods: Ten adult cadaveric knee specimens were prepared and analyzed under 5 different conditions: (1) intact state, (2) transected MPFC, (3) isolated MPFL reconstruction, (4) isolated MQTFL reconstruction, and (5) combined MPFL/MQTFL reconstruction. Patellar tilt, lateral patellar translation, patellofemoral contact forces, and patellofemoral contact areas were measured in each condition from 0° to 80° through simulated knee flexion using a custom servohydraulic load frame with pressure sensor technology and a motion capture system for kinematic data acquisition. Results: The isolated MPFL, isolated MQTFL, and combined MPFL/MQTFL reconstruction conditions produced significantly less lateral patellar tilt compared with the transected MPFC state ( P < .05). No statistically significant differences were found when each reconstruction technique was compared with the intact state in patellar tilt, lateral patellar translation, contact forces, and contact areas. Conclusion: All 3 reconstruction techniques (isolated MPFL reconstruction, isolated MQTFL reconstruction, and combined MPFL/MQTFL reconstruction) restored native knee kinematics, contact forces, and contact areas without overconstraint. Clinical Relevance: Isolated MPFL reconstruction, isolated MQTFL reconstruction, and combined MPFL/MQTFL reconstruction all restore patellofemoral stability comparable with the intact MPFC state without the overconstraint that could be concerning for increasing risk of patellofemoral arthritis.

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