Impact of Five Different Medial Patellofemoral Ligament-reconstruction Strategies and Three Different Graft Pre-tensioning States on the Mean Patellofemoral Contact Pressure: a Biomechanical Study on Human Cadaver Knees

Overview

Journal J Exp Orthop

Publisher Wiley

Specialty Orthopedics

Date 2018 Jun 30

PMID 29956015

Citations 10

Authors

Daniel Dornacher

Sabine Lippacher

Manfred Nelitz

Heiko Reichel

Anita Ignatius

Lutz Durselen

Andreas Martin Seitz

Affiliations

Soon will be listed here.

Abstract

Background: The medial patellofemoral ligament (MPFL) is the main stabiliser of the patella and thus mostly reconstructed in the surgical treatment of patellofemoral dislocation. The aims of this study were to gain a better understanding of the influence of altered MPFL graft-fixation locations and different graft pre-tensions on patellofemoral contact pressure.

Methods: Six human cadaveric knee joints were placed in a six-degree-of-freedom knee simulator. Mean PFCP (mPFCP) was evaluated in knee flexion of 0, 30 and 90° using a calibrated pressure-measurement system. After data assessment of the native knee joint, five MPFL reconstruction conditions were conducted: Anatomical double bundle; non-anatomical proximal patellar; non-anatomical distal patellar; non-anatomical proximal femoral; non-anatomical ventral femoral. The gracilis graft was fixed at a defined knee flexion of 30° and pre-tensioned to 2, 10 and 20 N.

Results: Kruskal-Wallis testing resulted in no mPFCP differences between the native and anatomical reconstruction states. Comparing the native and anatomical reconstruction states with the non-anatomical reconstruction states, no difference in the mPFCP both in knee extension (0°) (p>0.366) and in 30° knee flexion (p>0.349) was found. At 90° knee flexion, the following differences were identified: compared to the native knee state, the mPFCP increased after non-anatomical proximal femoral and non-anatomical ventral femoral reconstruction by 257% (p=0.04) and 292% (p=0.016), respectively. Compared to the anatomical reconstruction state, the mPFCP increased after non-anatomical proximal femoral reconstruction by 199% (p=0.042).

Discussion And Conclusions: With respect to all study findings and to restore a physiological PFCP, we recommend using the anatomical footprints for MPFL reconstruction and a moderate graft pretensioning of 2-10 N.

Citing Articles

Biomechanical Properties and Kinematics of Medial Patellofemoral Ligament Reconstruction: A Systematic Review.

Walsh J, Credille K, Allahabadi S, Kaplan D, Darbandi A, Huddleston H Orthop J Sports Med. 2024; 12(6):23259671241241537.

PMID: 38855071 PMC: 11159569. DOI: 10.1177/23259671241241537.

No Difference in Pullout Strength Between a Bio-inductive Implant and a Semitendinosus Tendon Graft in a Biomechanical Study of Medial Patellofemoral Ligament Repair Augmentation.

Wetzler A, McMillan S, Brewer E, Patel A, Handy S, Wetzler M Arthrosc Sports Med Rehabil. 2024; 6(1):100827.

PMID: 38313861 PMC: 10834473. DOI: 10.1016/j.asmr.2023.100827.

The Adductor Sling Technique for Pediatric Medial Patellofemoral Ligament Reconstruction Better Resists Dislocation Loads When Compared With Adductor Transfer at Time Zero in a Cadaveric Model.

Balazs G, Meyers K, Dennis E, Maher S, Shubin Stein B Arthrosc Sports Med Rehabil. 2024; 6(1):100831.

PMID: 38169763 PMC: 10758716. DOI: 10.1016/j.asmr.2023.100831.

A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Primary Patellar Instability and Need for Recurrent Surgical Stabilization.

Chang K, Albright J, Quinn M, Khatri S, Zhao L, Byrne R Sports Health. 2023; 16(3):465-472.

PMID: 37208906 PMC: 11025508. DOI: 10.1177/19417381231172726.

Autologous semitendinosus meniscus graft significantly improves knee joint kinematics and the tibiofemoral contact after complete lateral meniscectomy.

Seitz A, Leiprecht J, Schwer J, Ignatius A, Reichel H, Kappe T Knee Surg Sports Traumatol Arthrosc. 2023; 31(7):2956-2965.

PMID: 36604322 PMC: 10276070. DOI: 10.1007/s00167-022-07300-z.

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