Does Degree of Trochlear Dysplasia and Position of Femoral Tunnel Influence Outcome After Medial Patellofemoral Ligament Reconstruction?

Hopper, Graeme P.; Leach, W. J.; Rooney, Brian; Walker, Colin; Blyth, Mark

doi:10.1177/0363546513518413

Cited by 152 publications

(147 citation statements)

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“…18 Length changes of the reconstructed MPFL were most sensitive to femoral tunnel malpositioning, particularly in the proximal-distal axis. 17,18 Although graft isometry can be checked during MPFL reconstruction, intraoperative fluoroscopy has been recommended to guide femoral tunnel placement, 7,15 orientation at the anatomic landmarks described as the Schöttle point, 14 or the use of the 40%-50%-60% rule provided by Stephen et al 18 Nonetheless, the femoral tunnel was placed nonanatomically in 31% to 64% of reported MPFL reconstructions, 8,15 which suggests that femoral tunnel placement is prone to malpositioning, which may increase medial patellofemoral contact pressure and loss of knee flexion due to nonisometric length changes of the graft during knee joint motion. 17,18 Therefore, this study evaluated the sensitivity of femoral tunnel placement using lateral fluoroscopic guidance to minor degrees of hip abduction, adduction, and internal or external rotation.…”

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confidence: 99%

Accuracy of Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction

Balcarek

Walde

2015

Am J Sports Med

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confidence: 99%

Accuracy of Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction

Balcarek

Walde

2015

Am J Sports Med

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“…10,21 Several groups of authors have specifically detected an association between trochlear dysplasia and poorer outcomes or outright failure following MPFL reconstruction. 8,10,21 Although they found a high rate of success of MPFL reconstruction in children and adolescents, Nelitz and colleagues 10 noted that 2 patients with high-grade dysplasia demonstrated a persistently positive apprehension test. Hopper et al 8 reported that only 9.3% of their patients with mild trochlear dysplasia developed recurrent dislocation postoperatively, compared with all 7 of their patients with severe dysplasia.…”

Section: Editorialmentioning

confidence: 99%

“…8,10,21 Although they found a high rate of success of MPFL reconstruction in children and adolescents, Nelitz and colleagues 10 noted that 2 patients with high-grade dysplasia demonstrated a persistently positive apprehension test. Hopper et al 8 reported that only 9.3% of their patients with mild trochlear dysplasia developed recurrent dislocation postoperatively, compared with all 7 of their patients with severe dysplasia. Similarly, Wagner et al 21 described a negative relationship between the degree of trochlear dysplasia and subjective outcomes.…”

Section: Editorialmentioning

confidence: 99%

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Reider¹

2015

Am J Sports Med

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The discovery of a new dish does more for the happiness of the human race than the discovery of a star.-Jean Anthelme Brillat-Savarin;The Physiology of Taste: Or, Meditations on Transcendental Gastronomy Surgeons lucky enough to have attended the 10th Biennial Congress of ISAKOS, the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, in Lyon this year were treated to an experience that they will not soon forget. Readers who participated in the June event will understand what I mean. Personally, I know that years from now I will still begin to salivate like a Pavlovian hound whenever I recall the Poêle´e de gros escargots, girolles et chanterelles that drew me back to Bistrot Gustave, or the Foie gras de canard poêle´that massaged my tastebuds at Le Gourmet de Seze. Perhaps you preferred the Oeufs en meurettes, the Cabillaud à l'aoli, the Quenelles lyonnaises, or the Rognons de veau rotis from your favorite bistrot, bouchon, or restaurant. There was a real danger that the scientific knowledge gained each day from the many outstanding presentations might be erased by the nightly food coma that inevitably followed.The exalted position of Lyon in the gastronomic firmament is legendary, but the city is renowned for many other things, including silk, Roman amphitheaters, the French Resistance, and knee surgery 4 ; the latter item making it a particularly fitting locale for the ISAKOS congress. Names like Trillat, DeJour, Imbert, Bousquet, Chambat, Moyen, Walch, and Neyret immediately come to mind. My last visit to Lyon was as an AOSSM-ESSKA traveling fellow in 1986, when I had the good fortune to meet most of these luminaries and watch them practice their art.Given the importance of gastronomy in the Lyonnais consciousness, it is not surprising that an epicurean analogy should find its way into the vocabulary of knee surgery. French restaurants typically offer their patrons several options for composing their meal. Often a plat du jour is available: a single featured dish of the day offered at a very attractive price. For a bit more variety, one may choose le menu, a list of dishes at a set price with a limited number of choices for the appetizer, main course, and dessert. The different meanings of the word menu in

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“…Isometry of the reconstructed ligament is considered to be a prerequisite to a good outcome and an anatomical placement of the graft is the key to accomplish this [19].…”

Section: Introductionmentioning

confidence: 99%

An evaluation of the effectiveness of medial patellofemoral ligament reconstruction using an anatomical tunnel site

Valkering

Rajeev

Caplan

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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PurposeMedial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability has gained popularity and anatomical and biomechanical studies have recently altered our operative techniques. The aim of this study was to report the clinical outcome of this new anatomical MPFL reconstructive technique and investigate whether correlating factors could be identified. MethodsBetween 2009 and 2012, a total of 31 consecutive patients underwent MPFL reconstruction using an autologous gracilis graft and anatomical tunnel placement.Pre-and post-operative data were collected as a part of routine clinical practice. The preoperative assessment included a rotational profile CT scan of the lower extremity according to the Lyon protocol with TT-TG distance measurement. Outcomes were evaluated with the Kujala and Norwich patella instability (NPI) scores preoperatively and at follow-up (1.5-5.1 years). ResultsA significant improvement of both the Kujala (p<0.001) and NPI (p=0.012) scores was recorded. A medium and large negative correlation were found between TT-TG distance and Kujala score improvement (rho=-0.48, p=0.020) and NPI score improvement (rho=-0.83, p=0.042), respectively. Multiple regression analysis identified TT-TG distance, Beighton score and BMI as factors explaining the variance of Kujala score improvement. ConclusionAnatomical MPFL reconstruction with the gracilis autograft for patellar instability resulted in good outcome. This underlines the importance of anatomical tunnel placement in MPFL reconstruction. With a precise preoperative work-up, factors can be identified that may guide selecting the optimal operative strategy and improve counseling of the patient.

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Does Degree of Trochlear Dysplasia and Position of Femoral Tunnel Influence Outcome After Medial Patellofemoral Ligament Reconstruction?

Abstract: This study demonstrates the importance of restoration of the anatomic insertion point of the MPFL when performing MPFL reconstruction and proposes that this procedure should not be performed in isolation in patients with high-grade trochlear dysplasia.

Cited by 152 publications

References 36 publications

Accuracy of Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction

Accuracy of Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction

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An evaluation of the effectiveness of medial patellofemoral ligament reconstruction using an anatomical tunnel site

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