The favourable anisometry: An original concept for medial patellofemoral ligament reconstruction

Thaunat, Mathieu; Erasmus, Pieter J.

doi:10.1016/j.knee.2007.08.008

Cited by 103 publications

(72 citation statements)

References 16 publications

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“…That led to the suggestion that it might be preferable to ensure that the MPFL graft was longest in extension, slackening in flexion. 30 That would avoid over-pressurizing the medial trochlea and fits with our data.…”

Section: Discussionsupporting

confidence: 68%

Length change patterns of the extensor retinaculum and the effect of total knee replacement

Ghosh

Merican

Iranpour-Boroujeni

et al. 2009

Journal Orthopaedic Research

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Patellofemoral dysfunction following total knee replacement (TKR) is a significant clinical problem, but little information exists on the mechanics of the patellofemoral retinacula or the effects of TKR on these structures. We hypothesized that TKR would cause significant elongation of the retinacula. Retinacular length changes were measured by threading sutures along the retinacula, fixing the sutures to the patella and the iliotibial band (ITB), and attaching the femoral ends to displacement transducers. The intact knee was flexed-extended while the quadriceps and ITB were tensed and the retinacular length change patterns were recorded. The measurements were repeated post-TKR. The medial patellofemoral ligament (MPFL) was close to isometric, stretching 2 mm in terminal knee extension, whereas the lateral retinaculum slackened 8 mm from 1108 to 08 flexion. TKR did not cause significant elongation of either of the retinacula, the largest change being 3 mm elongation of the MPFL around 408, which stretched the MPFL by 1.4 mm above its maximum natural length. Thus, this work did not support the hypothesis that TKR causes significant elongation of the retinacula sufficient to affect knee function. Keywords: knee; patellofemoral; retinaculum; TKR; length change patterns Demand is increasing for improved knee function after surgery. Despite continuing evolution in prosthesis design and surgical methods, stiffness after total knee replacement (TKR) remains a disabling complication. The prevalence appears to be relatively low, but has not been clearly defined, primarily due to ambiguity in the literature concerning its definition. The prevalence of knee stiffness was recently reported as 1.3%-3.7%, 1,2 though higher levels (8%-12%) were reported in older literature. 3Stiffness after TKR may be caused by limited preoperative motion, biological predisposition, intraoperative technical problems, poor patient motivation, and inadequate postoperative rehabilitation.1,4--6 During knee motion, tensions in the ligaments, capsule, and extensor envelope may restrict flexion and affect implant wear.6,7 Awareness of the role of the extensor retinaculum in patellofemoral kinematics is increasing.8 While studies to date have focused on its role in patellar instability, [8][9][10][11] the influence of TKR is unknown. The positioning and thickness of TKR components may cause the surrounding soft tissues to be stretched. Abnormal soft tissue tensions post-arthroplasty may alter patellofemoral kinematics and stability; the literature shows that these mechanical factors can lead to clinical problems such as pain, stiffness, and excessive wear. Our aims were: to measure the length change patterns of the medial and lateral retinacula during knee extension; and to test the hypothesis that insertion of a TKR would cause significant elongations of the retinacula. MATERIALS AND METHODS Specimen PreparationEight right knees aged 69 years (range, 57-87 years) and including 20 cm of femur and 15 cm of tibia were obtained from a tissue b...

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Section: Discussionsupporting

confidence: 68%

Length change patterns of the extensor retinaculum and the effect of total knee replacement

Ghosh

Merican

Iranpour-Boroujeni

et al. 2009

Journal Orthopaedic Research

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“…The superior bundle was tight at full extension and the inferior bundle was tight at 30°of knee flexion and the whole MPFL is nonisometric [20]. To restore the native ligament, Thaunat and Erasmus introduced the "favorable anisometry" technique where the graft is tensioned in extension and progressive slackening of the graft could be achieved as the knee flexes [21]. Simpler than the above technique, the self-balance technique can adjust the graft tension of two functional bundles at the same time and complete the nonisometric behavior of the MPFL.…”

Section: Discussionmentioning

confidence: 99%

A prospective randomized trial evaluating two different tensioning techniques for medial patellofemoral ligament reconstruction

et al. 2016

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“…3). To follow the favorable anisometry concept, the femoral tunnel was positioned anatomically and the tensionless graft was placed extra-articularly with the knee flexed 30 • [9,18,19] to avoid IT band syndrome over the medial condyle. Femoral fixation was accomplished with an interference screw (Fig.…”

Section: Surgical Techniquementioning

confidence: 99%

Medial patellofemoral ligament reconstruction for patellar instability following total knee arthroplasty: A review of 6 cases

Lamotte

Néri

Kawaye³

et al. 2016

Orthopaedics & Traumatology: Surgery & Research

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The favourable anisometry: An original concept for medial patellofemoral ligament reconstruction

Cited by 103 publications

References 16 publications

Length change patterns of the extensor retinaculum and the effect of total knee replacement

Length change patterns of the extensor retinaculum and the effect of total knee replacement

A prospective randomized trial evaluating two different tensioning techniques for medial patellofemoral ligament reconstruction

Medial patellofemoral ligament reconstruction for patellar instability following total knee arthroplasty: A review of 6 cases

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