Graft length change and radiographic assessment of femoral drill hole position for medial patellofemoral ligament reconstruction

Tateishi, Tetsuya; Tsuchiya, Masamitsu; Motosugi, Naoya; Asahina, Shintaro; Ikeda, Hiroo; Cho, Sadahiro; Muneta, Takeshi

doi:10.1007/s00167-010-1235-9

Cited by 60 publications

(45 citation statements)

References 28 publications

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“…2,23,26,29,34,35,37 According to our results, 2 virtual ligaments including the medial femoral epicondyle (C1, C2) were less isometric than the other 6 ligaments (Figure 4); that is, the medial femoral epicondyle represents a less isometric point than the other 3 femoral points. This finding shows that, similar to previous in vitro studies, length changes of the reconstructed MPFL depend principally on the femoral attachment site.…”

Section: Discussionmentioning

confidence: 71%

Changes in the Length of the Medial Patellofemoral Ligament

et al. 2012

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Background: The ideal points for medial patellofemoral ligament (MPFL) reconstruction have not been precisely defined. Purpose: To determine at which flexion angles the grafts should be fixed to best restore patellar stability as well as to compare the length change of various femoral and patellar fixation sites for current MPFL reconstruction during knee flexion in vivo. Study Design: Descriptive laboratory study. Methods: The right knees of 10 living patients were scanned with a high-resolution computed tomography scanner at 0°, 30°, 60°, 90°, and 120° of knee flexion, and 3-dimensional knee models were constructed using customized software. Based on recent anatomic studies and current surgical techniques, 4 femoral points (A: adductor tubercle; B: midpoint between the medial epicondyle and the adductor tubercle; C: medial epicondyle; and D: 10 mm inferior to the adductor tubercle) and 2 patellar points (30% [point 1] and 45% [point 2] from the proximal pole of the patella) were marked. The lengths of the 8 ligaments were digitally measured, and the length changes of these ligaments at the 5 different knee flexion angles were calculated. Results: Two ligaments including the adductor tubercle (A1, A2) showed an increase while the knee was flexed over 60°. Four ligaments (B1, B2, D1, D2) showed a slight increase as the knee flexed from 0° to 30° and a decrease as the flexion angle exceeded 30°. Length changes in these 6 ligaments were not significantly different. There was no significant difference between 2 patellar points in the length changes of these 6 ligaments. Two ligaments including the medial epicondyle (C1, C2) showed an excessive decrease during knee flexion and showed greatest length changes. Conclusion: The femoral fixation sites should be located at point B or point D. Point A and point C are not ideal femoral fixation sites. The best angle for graft fixation would be near 30° of knee flexion. Clinical Relevance: The data obtained for length and length change pattern in each virtual ligament will serve as a useful basis for improved MPFL reconstruction.

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Section: Discussionmentioning

confidence: 71%

Changes in the Length of the Medial Patellofemoral Ligament

et al. 2012

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“…8 In addition, the femoral attachment position is reportedly critical to graft length changes in MPFL reconstruction, and the femoral tunnel center determines the graft length change pattern. 47 The same authors reported that length change pattern also determined early knee range of motion recovery and postoperative patellar alignment and suggested femoral tunnel position as being important to achieve good postoperative outcome. Furthermore, the most important factor affecting graft isometry is reported to be the position of the femoral attachment site.…”

Section: Discussionmentioning

confidence: 96%

Radiographic Reference Points Are Inaccurate With and Without a True Lateral Radiograph

2015

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“…First, the femoral anchoring site of the reconstructed MPFL is deviated slightly posteriorly, although still within the range of the reported area for the anchoring site, [13][14][15][16][17][18] to meet the demand of patients to sit squarely after surgery. When this point is used, the distance between the patellar and femoral attachment sites gradually shortens as the knee joint bends to more than 60 of flexion, regardless of the site of patellar attachment.…”

Section: Discussionmentioning

confidence: 83%

Reconstruction of the Medial Patellofemoral Ligament With Arthroscopic Control of Patellofemoral Congruence Using Electrical Stimulation of the Quadriceps

Suganuma

Mochizuki

Shibata

et al. 2016

Arthroscopy Techniques

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Reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar dislocation provides significant improvements in knee function. However, various complications have been reported, with most attributed to incorrect positioning of anchoring sites for the reconstructed MPFL and inappropriate graft tension. Patellofemoral congruence at 30 of flexion on arthroscopy was therefore controlled using devices able to modify the length of the reconstructed MPFL. This was done under circumstances of external rotation of the knee joint and electrical stimulation of the quadriceps with the purpose of maintaining the patella in a lateral shift. Advantages of this technique include completely controllable correction on arthroscopy under the worst patellofemoral congruence induced by external rotation of the knee joint and electrical stimulation of the quadriceps at 30 of flexion of the knee joint; in other words, voluntary determination of lateral shift during arthroscopy.

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Graft length change and radiographic assessment of femoral drill hole position for medial patellofemoral ligament reconstruction

Abstract: The femoral tunnel position is reaffirmed to be an essential determinant for the graft length change in the MPFL reconstruction. Both graft length change measurements and intraoperative radiographic assessment are practical for proper graft placement.

Cited by 60 publications

References 28 publications

Changes in the Length of the Medial Patellofemoral Ligament

Changes in the Length of the Medial Patellofemoral Ligament

Radiographic Reference Points Are Inaccurate With and Without a True Lateral Radiograph

Reconstruction of the Medial Patellofemoral Ligament With Arthroscopic Control of Patellofemoral Congruence Using Electrical Stimulation of the Quadriceps

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