Medial Patellofemoral Ligament Reconstruction: Impact of Knee Flexion Angle During Graft Fixation on Dynamic Patellofemoral Contact Pressure—A Biomechanical Study

Lorbach, Olaf; Zumbansen, Nikolaus; Kieb, Matthias; Efe, Turgay; Pizanis, A.; Kohn, Dieter; Haupert, Alexander

doi:10.1016/j.arthro.2017.09.047

Cited by 35 publications

(29 citation statements)

References 41 publications

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“…Cadaveric experiments have been conducted that show the achievement of physiological patellofemoral biomechanics, like that of the native knee with static MPFL reconstructions [15][16][17]. Cartilage degeneration after a static MPFLr has been related to graft overtension or an incorrect femoral attachment point [16,17]. Several biomechanical studies based on the finite element (FE) method have evaluated the MPFLr [18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Sanchis-Alfonso

Ginovart²,

Alastruey-López

et al. 2019

JCM

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Objectives: To evaluate the effect of various medial patellofemoral ligament (MPFL) fixation techniques on patellar pressure compared with the native knee. Methods: A finite element model of the patellofemoral joint consisting of approximately 30,700 nodes and 22,200 elements was created from computed tomography scans of 24 knees with chronic lateral patellar instability. Patellar contact pressures and maximum MPFL graft stress at five positions of flexion (0°, 30°, 60°, 90°, and 120°) were analyzed in three types of MPFL reconstruction (MPFLr): (1) static/anatomic, (2) dynamic, using the adductor magnus tendon (AMT) as the femoral fixation, and (3) dynamic, using the quadriceps tendon as the attachment (medial quadriceps tendon-femoral ligament (MQTFL) reconstruction). Results: In the static/anatomic technique, the patellar contact pressures at 0° and 30° were greater than in the native knee. As in a native knee, the contact pressures at 60°, 90°, and 120° were very low. The maximum MPFL graft stress at 0° and 30° was greater than in a native knee. However, the MPFL graft was loose at 60°, 90°, and 120°, meaning it had no tension. In the dynamic MPFLr using the AMT as a pulley, the patellar contact pressures were like those of a native knee throughout the entire range of motion. However, the maximum stress of the MPFL graft at 0° was less than that of a native ligament. Yet, the maximum MPFL graft stress was greater at 30° than in a native ligament. After 30° of flexion, the MPFL graft loosened, similarly to a native knee. In the dynamic MQTFL reconstruction, the maximum patellar contact pressure was slightly greater than in a normal knee. The maximum stress of the MPFL graft was much greater at 0° and 30° than that of a native MPFL. After 30° of flexion, the MQPFL graft loosened just as in the native knee. Conclusions: The patellar contact pressures after the dynamic MPFLr were like those of the native knee, whereas a static reconstruction resulted in greater pressures, potentially increasing the risk of patellofemoral osteoarthritis in the long term. Therefore, the dynamic MPFLr might be a safer option than a static reconstruction from a biomechanical perspective.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Sanchis-Alfonso

Ginovart²,

Alastruey-López

et al. 2019

JCM

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“…The graft was secured under adequate tension (qualitatively assessed) to act as a check rein, preventing patellar subluxation or dislocation. 22,23 In our study, we created a tunnel from the superior aspect of the medial femoral epicondyle and the graft fixed under tension with bioabsorbable screw after cycling the knee through its range of motion prior to fixation with the knee flexed at 30 degrees.…”

Section: Discussionmentioning

confidence: 99%

Medial Patellofemoral Ligament Reconstruction in Traumatic Patellar Dislocation without Patellar Fixation

Ibrahim¹,

Shohdy²,

Ramadan³

et al. 2019

J Knee Surg

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Acute traumatic patellar dislocation is a common injury, and spontaneous reduction may occur at the time of injury or may be reduced at the field of the accident by someone. It may be associated with osteochondral fractures and rupture of medial patellar stabilizers leading to recurrent patellar instability. The aim of this prospective study was to evaluate the outcomes of medial patellofemoral (PF) ligament (MPFL) reconstruction in recurrent traumatic patellar dislocation. Forty-five patients presented with PF instability as a result of traumatic rupture MPFL with normal patellar tracking underwent MPFL reconstruction without patellar fixation hardware through two parallel transpatellar tunnels and one screw in femoral tunnel. All patients were evaluated clinically preoperatively and at a minimum follow-up of 24 months, and International Knee Documentation Committee (IKDC) and Kujala scores were used to assess the clinical results. All patients were available for evaluation at a minimum of 24 months (up to 36 months). The mean age of these patients at the time of surgery was 22.82 years (range: 18–34 years). All patients gave history of trauma of their knees. Mean IKDC scale showed significant improvement as it rose from 47.17 preoperatively to 77.94 postoperatively, and mean Kujala score rose from 53.88 preoperatively to 86.24 postoperatively (p < 0.001). No recurrence of dislocation was recorded. Only three patients had mild atrophy of thigh and one patient had some difficulty in jumping. Reconstruction of MPFL by this method provides good clinical result in the treatment of PF instability by using autologous graft (semitendinosus and gracilis). Less hardware were used with less complications.

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“…The degree of knee flexion and amount of graft tension during fixation certainly determine dynamic contact pressures, kinematics, and potentially, persistence of anterior knee pain. 14,19 Graft tension remains a subjective aspect of MPFL reconstruction. Alternatively phrased, Farr and Schepsis 20 described "removing the slack" from the graft and setting the appropriate resting graft length rather than graft tension.…”

Section: See Related Article On Page 1130mentioning

confidence: 99%

Editorial Commentary: The “F” in MPFL (Medial Patellofemoral Ligament) Reconstruction—How Should We Fix It and Does It Matter?

Waterman¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Our understanding of the medial patellofemoral complex anatomy has evolved significantly over the past several decades, and this has informed our current surgical approach to management of lateral patellar instability. Medial patellofemoral ligament reconstruction remains the gold standard for decreasing the risk of secondary patellar dislocation and returning patients to active physical function. However, concerns about isometry, overconstraint, secondary arthrosis, and surgical-site morbidity remain with femoral socket fixation, particularly when patella alta, rotational malalignment, or hypermobility is present. Medial patellofemoral ligament reconstruction with soft-tissue fixation, on either the patellar or femoral side, may mitigate some of these risks by offering a more dynamic checkrein to lateral translation. However, longer-term studies are required to determine comparative efficacy with varying surgical techniques, and the ideal graft tension and degree of knee flexion during fixation have not yet been determined.

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Medial Patellofemoral Ligament Reconstruction: Impact of Knee Flexion Angle During Graft Fixation on Dynamic Patellofemoral Contact Pressure—A Biomechanical Study

Cited by 35 publications

References 41 publications

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Medial Patellofemoral Ligament Reconstruction in Traumatic Patellar Dislocation without Patellar Fixation

Editorial Commentary: The “F” in MPFL (Medial Patellofemoral Ligament) Reconstruction—How Should We Fix It and Does It Matter?

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