Lateral Release With Tibial Tuberosity Transfer Alters Patellofemoral Biomechanics Promoting Multidirectional Patellar Instability

Salvatore, Giuseppe; Berton, Alessandra; Orsi, Alexander; Egan, Jonathan; Walley, Kempland C.; Johns, William; Kheir, Nadim; Ramappa, Arun J.; DeAngelis, Joseph P.; Longo, Umile Giuseppe; Denaro, Vincenzo; Nazarian, Ara

doi:10.1016/j.arthro.2021.08.008

Cited by 9 publications

(14 citation statements)

References 57 publications

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“…This can explain the lesser amount of force needed to displace the patella laterally in the study by Bedi et al [18]. In addition, using the same FE model, these results are in line with the results when lateral release is performed concomitantly with a tibial tuberosity osteotomy to treat patellar instability when the TT-TG distance is greater than 12 mm [19]. Thus, regardless of the procedure being performed for patellar instability, the addition of LR will decrease the patellofemoral joint CA, CP and increase the lateral patellar displacement.…”

Section: Discussionsupporting

confidence: 72%

“…A previously developed and validated finite element (FE) model of the patellofemoral joint (PFJ) was used to simulate the conditions to understand the effect of lateral retinaculum release following MPFL reconstruction [19].…”

Section: Conditionsmentioning

confidence: 99%

“…The aim of this study is to study the effect of lateral release after acute MPFL reconstruction using a previously validated patellofemoral finite element model [19]. As the lateral retinaculum has been shown to contribute to medial and lateral stabilization of the patella in knees with an intact MPFL [16], we hypothesize that performing a lateral release when performing MPFL reconstruction will alter the biomechanics of the patellofemoral joint and increase the lateral instability of patella.…”

Section: Introductionmentioning

confidence: 99%

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Lateral release associated with MPFL reconstruction in patients with acute patellar dislocation

Kheir

Salvatore

Berton

et al. 2022

BMC Musculoskelet Disord

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Objective Medial patellofemoral ligament (MPFL) injury occurs in the majority of the cases of acute patellar dislocation. The role of concomitant lateral retinaculum release with MPFL reconstruction is not clearly understood. Even though the lateral retinaculum plays a role in both medial and lateral patellofemoral joint stability in MPFL intact knees, studies have shown mixed clinical outcomes following its release during MPFL reconstruction surgery. Better understanding of the biomechanical effects of the release of the lateral retinaculum during MPFL reconstruction is warranted. We hypothesize that performing a lateral release concurrent with MPFL reconstruction will disrupt the patellofemoral joint biomechanics and result in lateral patellar instability. Methods A previously developed and validated finite element (FE) model of the patellofemoral joint was used to understand the effect of lateral retinaculum release following MPFL reconstruction. Contact pressure (CP), contact area (CA) and lateral patellar displacement were recorded. abstract. Results FE modeling and analysis demonstrated that lateral retinacular release following MPFL reconstruction with tibial tuberosity-tibial groove distance (TT-TG) of 12 mm resulted in a 39% decrease in CP, 44% decrease in CA and a 20% increase in lateral patellar displacement when compared to a knee with an intact MPFL. In addition, there was a 45% decrease in CP, 44% decrease in CA and a 21% increase in lateral displacement when compared to a knee that only had an MPFL reconstruction. Conclusion This FE-based analysis exhibits that concomitant lateral retinaculum release with MPFL reconstruction results in decreased PF CA, CP and increased lateral patellar displacement with increased knee flexion, which may increase the risk of patellar instability.

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Section: Discussionsupporting

confidence: 72%

Section: Conditionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lateral release associated with MPFL reconstruction in patients with acute patellar dislocation

Kheir

Salvatore

Berton

et al. 2022

BMC Musculoskelet Disord

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“…[16][17][18][19] Some have quantified the effect of TP, either in isolation or with MPFLR, while others have quantified changes in patellar stability with tibial tubercle osteotomy, sometimes comparing between softtissue changes such as MPFR or lateral retinacular release. [16][17][18]20,21 However, a direct quantitative comparison of patellar stability between TP and mTTO procedures has not been published.…”

mentioning

confidence: 99%

Computational comparison of medializing tibial tubercle osteotomy and trochleoplasty in patients with trochlear dysplasia

Fitzpatrick

Steensen

Alvarez

et al. 2023

Journal Orthopaedic Research

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Medial patellofemoral ligament reconstruction (MPFLR) has emerged as the procedure of choice for recurrent patellar dislocation. This addresses soft tissue injury but does not address underlying anatomic factors, including trochlear dysplasia, that are commonly present and increase risk of dislocation. Quantification of the stability offered by other surgical interventions, namely, medializing tibial tubercle osteotomy (mTTO) and trochleoplasty, with and without MPFLR, may provide insight for surgical choices in patients with trochlear dysplasia. We developed subject‐specific finite element models based on magnetic resonance scans from a cohort of 20 patients with trochlear dysplasia and recurrent patellar dislocation. The objectives of this study were (1) to compare patella stability after mTTO and trochleoplasty procedures; (2) to evaluate whether it is necessary to perform an MPFLR in combination with the mTTO or trocheoplasty procedure; and (3) to quantify the robustness of patellar stability to variability in knee kinematics. Trochleoplasty performed better than mTTO at stabilizing the patella between 5° and 30° flexion. For both mTTO and trochleoplasty procedures, it was beneficial to also perform MPFLR—inclusion of MPFLR halved the magnitude of patellar laxity predicted in the simulations. Simulations that did not include any medial patellofemoral ligament restraint were also more sensitive to variation in tibiofemoral internal–external kinematics.

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“…Salvatore, Berton, Orsi, Egan, Walley, Johns, Kheir, Ramappa, DeAngelis, Longo, Denaro, and Nazarian aimed to develop a finite element model and characterize the effects of lateral release when combined with tibial tuberosity osteotomy (TTO) on patellofemoral contact pressures and kinematics. 5 The model was developed from magnetic resonance images of a cadaveric knee and validated with cadaveric experiments. The conditions of increased tibial tuberosity offset by 5 and 10 mm were evaluated in the setting of medial patellofemoral ligament (MPFL) deficiency, followed by a simulated TTO procedure with lateral release.…”

mentioning

confidence: 99%

Editorial Commentary: Handling the (Contact) Pressure in Patellofemoral Surgery: The Role of Lateral Retinacular Release

Tanaka¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Lateral Release With Tibial Tuberosity Transfer Alters Patellofemoral Biomechanics Promoting Multidirectional Patellar Instability

Cited by 9 publications

References 57 publications

Lateral release associated with MPFL reconstruction in patients with acute patellar dislocation

Lateral release associated with MPFL reconstruction in patients with acute patellar dislocation

Computational comparison of medializing tibial tubercle osteotomy and trochleoplasty in patients with trochlear dysplasia

Editorial Commentary: Handling the (Contact) Pressure in Patellofemoral Surgery: The Role of Lateral Retinacular Release

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