“…Discrepancies at the 5-mm insertion site increase graft elongation by up to 12 mm during flexion extension, 12,16 which is reflected in increased patellofemoral contact pressures 13,17 and clinically in pain, joint cartilage wear and eventually future repeated surgical intervention of the patient. If the graft is fixed in a more proximal position it will lead to an increase in the distance between the femoral anchor point and the patella during knee flexion, increasing tension and with it the pressure on the medial aspect of the patellofemoral joint.…”
Section: Discussionmentioning
confidence: 99%
“…Then, with the knee in 60° flexion, pulling and joining both ends, the fixation is decided, while allowing a +1 or +2 glide of the patella. 3 , 12 , 13 , 14 The proximal end is sutured with the distal end, anterior to the patella with the VICRYL 1.0 suture and passing the stitches over the remaining tissue of the retinaculum and anterior fibers of the quadricipital tendon ( Fig 6 ). Fig 6 Final anterior view of the dynamic fixation of the MPFL.…”
Section: Surgical Technique (With Video Illustration)mentioning
Patellar dislocation is a common knee problem, 10 times more frequent in childhood and adolescence. Medial patellofemoral ligament is injured up to 94% of the time, and its reconstruction is effective in terms of stabilization of the patella. However, distal femoral physis can be damaged with different techniques of reconstruction, due to the location of the femoral footprint. The purpose of this Technical Note is to describe a quasi-anatomical and dynamic reconstruction of the medial patellofemoral ligament, using no tunnel in the femur, passing the graft behind the adductor tendon, and fixing it with one tunnel in the patella and one passage through the quadriceps tendon.
“…Discrepancies at the 5-mm insertion site increase graft elongation by up to 12 mm during flexion extension, 12,16 which is reflected in increased patellofemoral contact pressures 13,17 and clinically in pain, joint cartilage wear and eventually future repeated surgical intervention of the patient. If the graft is fixed in a more proximal position it will lead to an increase in the distance between the femoral anchor point and the patella during knee flexion, increasing tension and with it the pressure on the medial aspect of the patellofemoral joint.…”
Section: Discussionmentioning
confidence: 99%
“…Then, with the knee in 60° flexion, pulling and joining both ends, the fixation is decided, while allowing a +1 or +2 glide of the patella. 3 , 12 , 13 , 14 The proximal end is sutured with the distal end, anterior to the patella with the VICRYL 1.0 suture and passing the stitches over the remaining tissue of the retinaculum and anterior fibers of the quadricipital tendon ( Fig 6 ). Fig 6 Final anterior view of the dynamic fixation of the MPFL.…”
Section: Surgical Technique (With Video Illustration)mentioning
Patellar dislocation is a common knee problem, 10 times more frequent in childhood and adolescence. Medial patellofemoral ligament is injured up to 94% of the time, and its reconstruction is effective in terms of stabilization of the patella. However, distal femoral physis can be damaged with different techniques of reconstruction, due to the location of the femoral footprint. The purpose of this Technical Note is to describe a quasi-anatomical and dynamic reconstruction of the medial patellofemoral ligament, using no tunnel in the femur, passing the graft behind the adductor tendon, and fixing it with one tunnel in the patella and one passage through the quadriceps tendon.
“…From 10 original articles included in this review, nine studies identified multiple fibers of MPFL for assessment of length change [7,14,21,22,[24][25][26][27][28] and one study assessed only a single fiber [23]. Various femoral and patellar attachments were analyzed, as specified in Table 2.…”
Section: Study Design As the Source Of Heterogeneity 41 Identification Of Measured Fibers And Measurement Methodsmentioning
confidence: 99%
“…Nine studies performed measurements in 3D [14,[21][22][23][24][25][26][27][28]; however, only in four was MPFL measured with respect to its convexity [7,14,24,25]. CT was utilized in four studies [14,22,24,25], caliper in two studies [21,27], MRI in one study [7], suture in one study [23], and other measurement methods in two studies [26,28]. Only five out of 10 studies reported precision of measurements [14,21,23,24,27].…”
Section: Study Design As the Source Of Heterogeneity 41 Identification Of Measured Fibers And Measurement Methodsmentioning
confidence: 99%
“…While it is not clear whether demographics influence biomechanics of MPFL, it was reported to influence the biomechanics of other ligaments, potentially making it important to precisely report number, age, and sex of patients/cadavers [16,20]. Within original studies included in this review, all 10 articles reported number of patients/cadavers [7,14,[21][22][23][24][25][26][27][28]; however, only seven studies specified the age of patients/cadavers [7,14,[22][23][24][25][26], and also seven studies reported the sex of patients/cadavers [7,14,[21][22][23][24][25]. Within included review articles, only one of them investigated number of patients/cadavers and their age as potential factors influencing MPFL length change pattern [16].…”
Section: Demographics As the Source Of Heterogeneitymentioning
Background: In the literature there are divergent results as to the native MPFL length change pattern. The reason for such divergent results may be the heterogeneity of design of studies analyzing MPFL isometry. The hypothesis of this review was that studies assessing MPFL length change pattern are highly heterogenous. The aim was to present a state-of-the-art review of sources of this heterogeneity. Materials and Methods: A total of 816 records were identified through the initial search of MEDLINE and Scopus databases. After eligibility assessment, 10 original articles and five reviews were included. In the included studies, the following 15 potential sources of heterogeneity were assessed: number of patients/cadavers, age, males to females ratio (demographics), identification of measured fibers, measurement method, measurement precision, quadriceps muscle activity, iliotibial band activity, hamstrings activity (study design), patellar height, trochlear or patellar dysplasia, femoral anteversion, mechanical axis of the limb, tibial tubercle–trochlear groove distance, and condylar anteroposterior dimensions (morphology). Each variable was graded in every included article with 1 point if reported precisely and not introducing bias; or with 0 points if reported not precisely, introducing bias, or not reported at all. Results: Within original articles, the highest achieved score was 10 out of 15 possible points with mean score of 6.7, SD = 2.37, and minimum score of just 3 out of 15 points. In the demographics section, mean score was 2.4, SD = 0.8 (80% of maximum possible score of 3); in the study design section it was 3.1, SD = 1.87 (52% of maximum possible score of 6); and in the morphology section it was 1.5, SD = 1.43 (25% of maximum possible score of 6). Conclusions: There is high heterogeneity and incomplete reporting of potential sources of bias in studies assessing native MPFL length change pattern. Future investigators should be aware of the presented factors and their potential impact on MPFL isometry. All methodologic factors should be meticulously reported. Detailed description of demographic data is already a standard; however, authors should more extensively report variables concerning study design and morphology of patients’ patellofemoral joint. Furthermore, future studies should try to meticulously simulate the real-life working environment of MPFL and ensure usage of proper measurement methods.
Purpose Isolated MPFL reconstruction (iMPFLR) is increasingly used for the surgical treatment of treatment for recurrent patella dislocation. The purpose of this study was to evaluate the inluence of tunnel widening and migration on clinical outcomes after iMPFL using a CT-scannographic analysis at 6 months postoperatively. Methods One hundred and sixty patients (91 females for 69 males) with an average age of 23 years [14-54] who underwent iMPFLR and had an evaluation scan at 6 months postoperatively were evaluated with a mean follow-up of 97 ± 89 months [12 to 166]. Functional International Knee Documentation Committee (IKDC) Score, Kujala score, and joint mobility were assessed preoperatively, at 6 months and at the latest follow-up. The IKDC and Kujala scores were expressed as the diference between pre-and postoperative scores (dIKDC and dKujala). The position of the femoral tunnel was assessed according to the Schöttle criteria on post-operative radiographic proiles. Tunnel widening (at three levels of measurement) and the migration of the center of the tunnel were studied on a CT-scan analysis at 6 months. Any correlation and regression between the evolution of the clinical scores and the measured scannographic parameters were investigated. The relationships between tunnel position and tunnel changes were also studied. Results Between pre-and post-op, the IKDC (45 ± 13 to 80 ± 15, p < 0.001) and Kujala (55 ± 11 to 87 ± 12, p < 0.001) scores were signiicantly improved. Patients with tunnel changes had decreased clinical and functional results at 6 months post-op of an iMPFLR (p < 0.001). These changes in the femoral tunnel, evidenced by a tunnel entrance widening and migration of the tunnel center, were related to an initial malposition of the tunnel (p < 0.001).
ConclusionIn iMPFLR, changes in the femoral tunnel, corresponding to dilatation and migration of the tunnel center, may occur. These changes are increased by the initial malpositioning of the femoral tunnel and are correlated with less good clinical and functional outcomes. Level of evidence Level IV.
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