The Effect of Reconstruction of the Medial Patellofemoral Ligament on Patellar Tracking

Sandmeier, Robert; Burks, Robert T.; Bachus, Kent N.; Billings, Annette

doi:10.1177/03635465000280031001

Cited by 147 publications

(129 citation statements)

References 11 publications

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“…3 While most follow-up studies reported that knee flexion after TKA of between 110 to 1208, 4 many studies investigated knee biomechanics in deep flexion to understand the biomechanical factors that may affect flexion capabilities. 1,2,[5][6][7][8][9] Among these factors, the function of the patellar tendon, an essential component of the extensor mechanism, plays a critical role.…”

mentioning

confidence: 99%

In‐vivo patellar tendon kinematics during weight‐bearing deep knee flexion

Kobayashi

Sakamoto

Hosseini

et al. 2012

Journal Orthopaedic Research

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This study quantified in-vivo 3D patellar tendon kinematics during weight-bearing deep knee bend beyond 1508. Each knee was MRI scanned to create 3D bony models of the patella, tibia, femur, and the attachment sites of the patellar tendon on the distal patella and the tibial tubercle. Each attachment site was divided into lateral, central, and medial thirds. The subjects were then imaged using a dual fluoroscopic image system while performing a deep knee bend. The knee positions were determined using the bony models and the fluoroscopic images. The patellar tendon kinematics was analyzed using the relative positions of its patellar and tibial attachment sites. The relative elongations of all three portions of the patellar tendon increased similarly up to 608. Beyond 608, the relative elongation of the medial portion of the patellar tendon decreased as the knee flexed from 608 to 1508 while those of the lateral and central portions showed continuous increases from 1208 to 1508. At 1508, the relative elongation of the medial portion was significantly lower than that of the central portion. In four of seven knees, the patellar tendon impinged on the tibial bony surface at 1208 and 1508 of knee flexion. These data may provide useful insight into the intrinsic patellar tendon biomechanics during a weight-bearing deep knee bend and could provide biomechanical guidelines for future development of total knee arthroplasties that are intended to restore normal knee function. ß 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30: [1596][1597][1598][1599][1600][1601][1602][1603] 2012 Keywords: patellar tendon elongation; patellar tendon orientation; deep knee flexion; weight-bearing activity; knee kinematics Maximum flexion of the knee reaches beyond 1508. 12 Restoration of knee function in the entire flexion range after total knee arthroplasty (TKA) has been challenging. 3 While most follow-up studies reported that knee flexion after TKA of between 110 to 1208, 4 many studies investigated knee biomechanics in deep flexion to understand the biomechanical factors that may affect flexion capabilities. 1,2,5-9 Among these factors, the function of the patellar tendon, an essential component of the extensor mechanism, plays a critical role.Numerous in vitro studies reported the material properties, 10,11 orientation, and/or moment arms of the patellar tendon. 12 In vivo studies measured patellar tendon elongation using ultrasound 13 and MRI. 14 MRI was also used to determine the orientation and moment arms of the patellar tendon. 15,16 Foil strain gages were used to measure the mid-point patellar tendon strain intra-operatively. 17 Recently, DeFrate et al. 18 investigated patellar tendon kinematics using a combined MRI and dual fluoroscopic image technique. However, most of these studies examined patellar tendon biomechanics within the range of knee flexion up to 1108. 18,19 Quantitative data on the patellar tendon function in deep knee flexion are still unclear.Our objective was ...

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mentioning

confidence: 99%

In‐vivo patellar tendon kinematics during weight‐bearing deep knee flexion

Kobayashi

Sakamoto

Hosseini

et al. 2012

Journal Orthopaedic Research

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“…In the last decade, important biomechanical investigations have been carried out confirming the importance of this ligament, demonstrating that it is the most important medial static structure for prevention of the patellar lateral dislocation, contributing with over 50% of this strength (19)(20)21) . An interesting biomechanical essay was performed by Sandmeieret al (22) , in which they promoted the MPFL reconstruction with the tendon of the gracilis muscle, observing reestablishment of normal patellofemoral exam after the ligament reconstruction. An important and little studied aspect of the MPFL is concerned with the maintenance of its function in the different degrees of knee flexion.…”

Section: Discussionmentioning

confidence: 99%

Importância do ligamento femoropatelar medial no deslocamento e na inclinação lateral da patela: estudo radiográfico em cadáveres

Fávaro

Severino²,

Fávaro

et al. 2011

Rev Bras Med Esporte

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Objective: Acute patellar luxation is a complex disease that mainly affects young patients. Its physiopathology is little known and the understanding of it and its therapeutic conduct are controversial. The medial patellofemoral ligament (MPFL) is the main static stabilizer for preventing lateral displacement of the patella. In order to assess the stability of the patellofemoral joint, the authors radiographically assessed the presence, or absence of lateral displacement and inclination of the patella before and after the MPFL section in the knees of cadavers. Methods: Thirty knees of cadavers were radiographed on the axial incidence of the patella by means of the technique described by Merchant before and after MPFL section. The Merchant congruence angle and Laurin lateral patellofemoral angle were measured. Results: The medial patellofemoral ligament presented mean length of 4.8cm, and width of 1.6 cm. In six anatomical pieces there was no change in the Laurin lateral patellofemoral angle (20%), in three anatomical pieces the change was one degree (10%), in 20 (67%) two degrees and in one anatomical piece it was four degrees (3%). Changes occurred between zero and two degrees in 97% of the knees of cadavers. In six anatomical pieces there was no change in the Merchant congruence angle (17%); in six anatomical pieces the change was one degree (20%), in 17 (57%) two degrees, in one anatomical piece it was three degrees (3%) and in one it was six degrees (3%). These changes occurred between zero and two degrees in 93% of the knees of cadavers. Conclusion: Analysis of the results obtained in this study allowed us to conclude that the medial patellofemoral ligament is important in the lateral inclination and displacement of the patella with knee flexed at 45º.

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“…[26] In absence of intact MPFL, patellar tracking is significantly affected by a laterally directed force, but returns to normal following reconstruction of MPFL. [27] Patient's selection is very much important while considering for MPFL reconstruction. Before doing MPFL reconstruction, it is important to distinguish common patellofemoral pain syndrome from anterior pain associated with patellar instability.…”

Section: Figure 6 Showing Tt-tg Distance In Overlapped Image Of Mrimentioning

confidence: 99%

Reconstruction of Medial Patellofemoral Ligament Through Two Transverse Patellar Tunnel Technique Using Hamstring Autograft

Kumar¹,

Samanta²,

Sil³

2017

jemds

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The Effect of Reconstruction of the Medial Patellofemoral Ligament on Patellar Tracking

Cited by 147 publications

References 11 publications

In‐vivo patellar tendon kinematics during weight‐bearing deep knee flexion

In‐vivo patellar tendon kinematics during weight‐bearing deep knee flexion

Importância do ligamento femoropatelar medial no deslocamento e na inclinação lateral da patela: estudo radiográfico em cadáveres

Reconstruction of Medial Patellofemoral Ligament Through Two Transverse Patellar Tunnel Technique Using Hamstring Autograft

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