The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability

Zaffagnini, Stefano; Colle, Francesca; Lopomo, N.; Sharma, Bharat; Bignozzi, S.; Dejour, David; Marcacci, Maurilio

doi:10.1007/s00167-012-2307-9

Cited by 73 publications

(58 citation statements)

References 37 publications

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“…The MPFL is a primary passive soft tissue restraint against lateral patellar displacement from 0° to 30° of knee flexion [1,12,24]. The patella is engaged in the trochlea, and the MPFL is gradually slack above 60° of knee flexion.…”

Section: Discussionmentioning

confidence: 99%

Simulation of the optimal femoral insertion site in medial patellofemoral ligament reconstruction

Oka

Matsushita

Kubo

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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Section: Discussionmentioning

confidence: 99%

Simulation of the optimal femoral insertion site in medial patellofemoral ligament reconstruction

Oka

Matsushita

Kubo

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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“…Sectioning the MPFL has increased patellar lateral shift and tilt of knees tested on a simulator by up to 9 mm and 8°, respectively, primarily near full extension [11–16]. Larger changes have been noted with a lateral force directly applied to the patella [14, 17, 18]. Cutting the MPFL has been shown to decrease the peak medial patellofemoral contact pressure but have no influence on the lateral pressure [17], with similar results obtained for the total contact pressure [19].…”

Section: Mpfl Reconstructionmentioning

confidence: 99%

Biomechanical Analysis of Tibial Tuberosity Medialization and Medial Patellofemoral Ligament Reconstruction

Elias¹,

Smith

Daney

2017

Sports Medicine and Arthroscopy Review

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Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and tibial tuberosity medialization on patellar tracking and patellofemoral contact pressures. The most common method is in vitro simulation of knee function, but computational simulation of knee function and computational reconstruction of in vivo motion can also be utilized. The current review of the biomechanical literature indicates that MPFL reconstruction and tibial tuberosity medialization reduce lateral patellar tracking. Decreased lateral patellofemoral contact pressures have also been noted. For MPFL reconstruction, the most commonly noted biomechanical concerns are graft over-tensioning and non-anatomical attachment on the femur leading to over-constraint of the patella and elevated medial contact pressures. For tuberosity medialization, the influence of altered tibiofemoral kinematics on post-operative function is unknown. Future biomechanical studies should emphasize inclusion of anatomical features and tracking patterns related to patellar instability, with comparison between the surgical approaches for continued development of treatment guidelines.

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“…The arguments for surgical treatment, whether repair or reconstruction, are: since a medial arthrotomy was used, a MPFL repair would be a reasonable procedure; some prospective studies begin to show better long term results for MPFL reconstruction, compared to those observed with conservative treatment [14]. As our knowledge about the biomechanical importance of the MPFL evolves -mainly its role against lateral displacement during motion and under high lateral stresses [15] -the more orthopaedic surgeons consider MPFL reconstruction the mainstay of treatment, even in the context of a primary APD [16]. Postoperatively, the McConnell tapping method was applied, with the goals of protecting and maintaining / improving the patellofemoral biomechanics [17].…”

Section: Discussionmentioning

confidence: 99%

Open Reduction and Internal Fixation of an Osteochondral Patellar Fracture in an Eleven Year-Old Girl

Correia¹

2016

MOJOR

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Osteochondral patellar fractures in pediatric age can result from acute patellar dislocations (APDs). The purpose of this article is to document and discuss the surgical treatment performed to a young female patient diagnosed with an osteochondral fracture (OCF) of the patella in the first episode of an APD.We state the first episode of an APD in a 12 year-old girl, who presented with pain, edema and limited extension of the right knee, after a direct knee trauma. She had no predisposing factors regarding patellofemoral instability. This patient was treated at our Orthopaedic Surgery Department and then clinically (Kujala score) and radiographically evaluated, at 12 months of follow-up.The knee radiograms gave rise to the suspicion of a large inferior osteochondral patellar fragment. Operative treatment was decided and open reduction and internal fixation (ORIF) of the fragment was performed, through a medial parapatellar approach. The fragment dimensions were 24x18mm. The medial structures were addressed and repaired. The patient went through a rehabilitation programme and returned to full activities three months postoperatively. After 12 months of follow-up, there was full range of motion, no redislocation episodes and the Kujala score was 96.Open reduction and anatomic in situ internal fixation of the osteochondral fragment was mandatory in this case, due to its dimensions and location. We consider this a safe and efficient technique that allows osteosynthesis of the osteochondral fragment; the approach used makes possible the acute repair of the medial structures. There is still no general consensus about whether or not to reconstruct the medial patellofemoral ligament (MPFL) in the context of a primary APD.

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The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability

Cited by 73 publications

References 37 publications

Simulation of the optimal femoral insertion site in medial patellofemoral ligament reconstruction

Simulation of the optimal femoral insertion site in medial patellofemoral ligament reconstruction

Biomechanical Analysis of Tibial Tuberosity Medialization and Medial Patellofemoral Ligament Reconstruction

Open Reduction and Internal Fixation of an Osteochondral Patellar Fracture in an Eleven Year-Old Girl

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