The Results of Adductor Magnus Tenodesis in Adolescents with Recurrent Patellar Dislocation

Małecki, Krzysztof; Fabiś, Jarosław; Flont, Paweł; Niedzielski, Kryspin

doi:10.1155/2015/456858

Cited by 22 publications

(34 citation statements)

References 42 publications

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“…All 3 MPFL reconstruction techniques specific to the skeletally immature athlete have been shown to be safe with a low rate of recurrent dislocation and morbidity. Malecki et al 29 demonstrated a 10% risk of recurrent of patellofemoral instability at 2.6 years in 33 skeletally immature patients using the adductor transfer technique. Sillanpää et al 45 found a 14% risk of recurrence at 8 years in a study comparing adductor transfer to the Roux Goldthwait distal soft tissue realignment procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The close proximity of the MPFL femoral insertion to the adductor tubercle has led others to use the adductor tendon for MPFL reconstruction, thus avoiding the need for a bony socket or fixation on the femoral side. 29,44,45 Sillanpää et al 44,45 has described utilizing the adductor tendon to re-create the MPFL by cutting the tendon 10 cm proximally and rerouting this tendon to the medial patella (''adductor transfer''). Dissection of the adductor magnus tendon can result in neurovascular injury given the proximity of the tendon to the adductor hiatus, saphenous nerve, and geniculate arteries 21 .…”

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confidence: 99%

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Comparison of Ligament Isometry and Patellofemoral Contact Pressures for Medial Patellofemoral Ligament Reconstruction Techniques in Skeletally Immature Patients

et al. 2020

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Background: Adult medial patellofemoral ligament (MPFL) reconstruction techniques are not appropriate for the skeletally immature patient given the proximity of the distal femoral physis. Biomechanical consequences of reconstructions aimed at avoiding the physis have not been adequately studied. Purpose: To quantify the biomechanical effects of MPFL reconstruction techniques intended for skeletally immature patients. Study Design: Controlled laboratory study Methods: Four MPFL reconstruction techniques were evaluated using a computationally augmented cadaveric model: (1) Schoettle point: adult-type reconstruction; (2) epiphyseal: socket distal to the femoral physis; (3) adductor sling: graft wrapped around the adductor tendon; (4) adductor transfer: adductor tendon transferred to patella. A custom testing frame was used to cycle 8 knees for each technique from 10° to 110° of flexion. Patellofemoral kinematics were recorded using a motion camera system, contact stresses were recorded using Tekscan pressure sensors, and MPFL length was computed using an inverse kinematics computational model. Change in MPFL length, patellar facet forces, and patellar kinematics were compared using generalized estimating equation modeling. Results: Schoettle point reconstruction was the most isometric, demonstrating isometry from 10° to 100°. The epiphyseal technique was isometric until 60°, after which the graft loosened with increasing flexion. The adductor sling and adductor transfer techniques were significantly more anisometric from 40° to 110°. Both grafts tightened with knee flexion and resulted in significantly more lateral patellar tilt versus the intact state in early flexion and significantly higher contact forces on the medial facet versus the epiphyseal technique in late flexion. Conclusion: In this cadaveric simulation, the epiphyseal technique allowed for a more isometric ligament until midflexion, when the patella engaged within the trochlear groove. The adductor sling and adductor transfer grafts became tighter in flexion, resulting in potential loss of motion, pain, graft stretching, and failure. Marginal between-condition differences in patellofemoral contact mechanics and patellar kinematics were observed in late flexion. Clinical Relevance: In the skeletally immature patient, using an epiphyseal type MPFL reconstruction with the femoral attachment site distal to the physis results in a more isometric graft compared with techniques with attachment sites proximal to the physis.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Comparison of Ligament Isometry and Patellofemoral Contact Pressures for Medial Patellofemoral Ligament Reconstruction Techniques in Skeletally Immature Patients

et al. 2020

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“…Donor-site tenderness and muscle retraction were outlined by previous authors as potential complications of this technique, but only in cases when there was a need to harvest the full volume of the tendon. 28,32,50,51 Similar complications have been reported in reconstruction techniques of other ligaments with the use of various tendinous graft sources (ie, quadriceps, semitendinosus, gracilis tendons). However, we strongly believe that the remaining volume, intact aponeurotic attachment, and medial intermuscular septum integrated with the fibers of the membranous segment of the tendon provide sufficient pull on the AT and minimize the possibility of postoperative muscle retraction.…”

Section: Discussionmentioning

confidence: 58%

“…Moreover, none of the previous studies that investigated the clinical outcomes of AT-MPFL cited the aforementioned postoperative complications. 10,32,49 During the anatomic evaluation, it was determined that the distance from the femoral insertion of the AT on the tubercle to the hiatus, measured at 10.8 6 1.3 cm, well exceeds the length of the native MPFL and that of the desired length of the graft at 7.5 6 0.5 cm. In other words, when the predetermined length of the graft was harvested, the hiatus was never reached; thus, the risk of an injury to the neurovascular structures remained minimal to none.…”

Section: Discussionmentioning

confidence: 99%

Anatomic and Biomechanical Properties of Flat Medial Patellofemoral Ligament Reconstruction Using an Adductor Magnus Tendon Graft: A Human Cadaveric Study

Milinkovic

Fink

Kittl³

et al. 2021

Am J Sports Med

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Background: In contrast to the majority of existing techniques for reconstruction of the medial patellofemoral ligament (MPFL), the technique described in this article uses the adductor magnus muscle tendon to gain a flat, broad graft, leaving its distal femoral insertion intact, and does not require drilling within or near the femoral physis. It also allows for soft tissue patellar fixation and could facilitate anatomic MPFL reconstruction in skeletally immature patients. Purpose: To evaluate the anatomic and structural properties of the native MPFL and the adductor tendon (AT), followed by biomechanical evaluation of the proposed reconstruction. Study Design: Descriptive laboratory study. Methods: The morphological and topographical features of the AT and MPFL were evaluated in 12 fresh-frozen cadaveric knees. The distance between the distal insertion of the AT on the adductor tubercle and the adductor hiatus, as well as the desired length of the graft, was measured to evaluate this graft’s application potential. Load-to-failure tests were performed to determine the biomechanical properties of the proposed reconstruction construct. The construct was placed in a uniaxial testing machine and cyclically loaded 500 times between 5 and 50 N, followed by load to failure, to measure the maximum elongation, stiffness, and maximum load. Results: The mean ± SD length of the AT was 12.6 ± 1.5 cm, and the mean distance between the insertion on the adductor tubercle and adductor hiatus was 10.8 ± 1.3 cm, exceeding the mean desired length of the graft (7.5 ± 0.5 cm) by 3.3 ± 0.7 cm. The distal insertion of the AT was slightly proximal and posterior to the insertion of the MPFL. The maximum elongation after cyclical loading was 1.9 ± 0.4 mm. Ultimately, the mean stiffness and load to failure were 26.2 ± 7.6 N/mm and 169.7 ± 19.2 N, respectively. The AT graft failed at patellar fixation in 2 of the initially tested specimens and at the femoral insertion in the remaining 10. Conclusion: The described reconstruction using the AT has potential for MPFL reconstruction. The AT graft presents a graft of significant volume, beneficial anatomic topography, and adequate tensile properties in comparison with the native MPFL following the data from previously published studies. Clinical Relevance: Given its advantageous anatomic relationship as an application that avoids femoral drilling and osseous patellar fixation, the AT may be considered a graft for MPFL reconstruction in skeletally immature patients.

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“…

Within the literature, a great deal of space has been devoted to operating techniques and the overall results of the treatment of recurrent patellar dislocation with MPFL, which is gaining popularity in recent times. [1][2][3][4][5][6][7] The MPFL plays a crucial role as a passive stabilizer of patella at 20 to 30 degrees of flexion and, along with the conditions of the anatomical shape of the femoral-patellar joint and the function of quadriceps, influences the overall patellar stability. 8-14 However, only a few studies have examined indirectly or directly the function of quadriceps with the help of gait analysis, 15,16 electromyography (EMG) evaluation, 2,13,17 isokinetic test, 5,6,12,18-21 and proprioception 22,23 in the case of recurrent patellar dislocation.

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confidence: 99%

Bilateral Hidden Isokinetic Quadriceps Performance before and after MPFL Reconstruction in Pediatric Patients

et al. 2020

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We perform prospective study to evaluate the isokinetic performance of quadriceps before and 1 year after medial patella-femoral ligament (MPFL) reconstruction with the adductor magnus tendon in the case of recurrent patellar dislocation. The present study is the first to describe the isokinetic function of the quadriceps of the involved and uninvolved extremity, in such a wide range. The MPFL is a crucial passive stabilizer of patella and, along with the conditions of the anatomical shape of the femoral-patellar joint and the function of quadriceps, influences the overall patellar stability. However, only a few studies have examined indirectly or directly the function of quadriceps. A total of 27 patients (average age at surgery was 15.8 years) with recurrent monolateral patellar dislocation were treated with MPFL reconstruction using the adductor magnus tendon. In the study group, healthy and operated quadriceps were evaluated for the following parameters at the velocities of 60 and 180 deg/s before surgery and in the follow-up examination: peak torque, peak torque to body weight, time to peak torque, peak torque angle, torque in 30 degree of the knee flexion (TQ 30 degree), and the torque in the first 180 milliseconds (TQ 180). Preoperative patellar instability and its normalization after MPFL reconstruction have no impact on the isokinetic quadriceps index value which depends on the time and degree of inactivity as well as implementation of appropriate physiotherapy. The increase in the quadriceps muscle strength of a healthy limb is responsible for the persistence of muscle isokinetic imbalance after MPFL reconstruction in pediatric patients. This is a level 2b study.

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The Results of Adductor Magnus Tenodesis in Adolescents with Recurrent Patellar Dislocation

Cited by 22 publications

References 42 publications

Comparison of Ligament Isometry and Patellofemoral Contact Pressures for Medial Patellofemoral Ligament Reconstruction Techniques in Skeletally Immature Patients

Comparison of Ligament Isometry and Patellofemoral Contact Pressures for Medial Patellofemoral Ligament Reconstruction Techniques in Skeletally Immature Patients

Anatomic and Biomechanical Properties of Flat Medial Patellofemoral Ligament Reconstruction Using an Adductor Magnus Tendon Graft: A Human Cadaveric Study

Bilateral Hidden Isokinetic Quadriceps Performance before and after MPFL Reconstruction in Pediatric Patients

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