Does radiographic location ensure precise anatomic location of the femoral fixation site in medial patellofemoral ligament surgery?

2015 ◽  
Vol 24 (9) ◽  
pp. 2838-2844 ◽  
Author(s):  
Vicente Sanchis-Alfonso ◽  
Cristina Ramirez-Fuentes ◽  
Erik Montesinos-Berry ◽  
Francisco Aparisi-Rodriguez ◽  
Luis Martí-Bonmatí
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Femoral Fixation ◽  
Anatomic Location

scholarly journals Radiographic Location Does Not Ensure a Precise Anatomic Location of the Femoral Fixation Site in Medial Patellofemoral Ligament Reconstruction

2017 ◽  
Vol 5 (11) ◽  
pp. 232596711773925 ◽  
Author(s):  
Vicente Sanchis-Alfonso ◽  
Cristina Ramírez-Fuentes ◽  
Erik Montesinos-Berry ◽  
Isabel Elía ◽  
Luis Martí-Bonmatí
Keyword(s):  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Femoral Fixation ◽  
Anatomic Location

scholarly journals Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198928
Author(s):  
Heath P. Gould ◽  
Nicholas R. Delaney ◽  
Brent G. Parks ◽  
Roshan T. Melvani ◽  
Richard Y. Hinton
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Graft Fixation ◽  
Mpfl Reconstruction ◽  
Suture Anchors ◽  
Femoral Fixation ◽  
Significant Difference ◽  
Load To Failure ◽  
The Mean

Background: Femoral-sided graft fixation in medial patellofemoral ligament (MPFL) reconstruction is commonly performed using an interference screw (IS). However, the IS method is associated with several clinical disadvantages that may be ameliorated by the use of suture anchors (SAs) for femoral fixation. Purpose: To compare the load to failure and stiffness of SAs versus an IS for the femoral fixation of a semitendinosus autograft in MPFL reconstruction. Study Design: Controlled laboratory study. Methods: Based on a priori power analysis, a total of 6 matched pairs of cadaveric knees were included. Specimens in each pair were randomly assigned to receive either SA or IS fixation. After an appropriate reconstruction procedure, the looped end of the MPFL graft was pulled laterally at a rate of 6 mm/s until construct failure. The best-fit slope of the load-displacement curve was then used to calculate the stiffness (N/mm) in a post hoc fashion. A paired t test was used to compare the mean load to failure and the mean stiffness between groups. Results: No significant difference in load to failure was observed between the IS and the SA fixation groups (294.0 ± 61.1 vs 250.0 ± 55.9; P = .352), although the mean stiffness was significantly higher in IS specimens (34.5 ± 9.6 vs 14.7 ± 1.2; P = .004). All IS reconstructions failed by graft pullout from the femoral tunnel, whereas 5 of the 6 SA reconstructions failed by anchor pullout. Conclusion: In this biomechanical study using a cadaveric model of MPFL reconstruction, SA femoral fixation was not significantly different from IS fixation in terms of load to failure. The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL. Clinical Relevance: These results suggest that SAs are a biomechanically viable alternative for femoral-sided graft fixation in MPFL reconstruction.

Isolated reconstruction of medial patellofemoral ligament with an elastic femoral fixation leads to excellent clinical results

2020 ◽  
Author(s):  
Vincent Marot ◽  
Vicente Sanchis-Alfonso ◽  
Simone Perelli ◽  
Pablo E. Gelber ◽  
Christian Javier Sánchez Rábago ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Clinical Results ◽  
Femoral Fixation

scholarly journals Medial Patellofemoral Ligament Reconstruction Procedure Using a Suspensory Femoral Fixation System

2013 ◽  
Vol 2 (4) ◽  
pp. e491-e495 ◽  
Author(s):  
Shuji Nakagawa ◽  
Yuji Arai ◽  
Hiroyuki Kan ◽  
Keiichiro Ueshima ◽  
Kazuya Ikoma ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Reconstruction Procedure ◽  
Femoral Fixation ◽  
Fixation System

scholarly journals Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis

2019 ◽  
Vol 7 (7) ◽  
pp. 232596711985502 ◽  
Author(s):  
Alan G. Shamrock ◽  
Molly A. Day ◽  
Kyle R. Duchman ◽  
Natalie Glass ◽  
Robert W. Westermann
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Medial Patellofemoral Ligament ◽  
Donor Site ◽  
Mpfl Reconstruction ◽  
Complication Rates ◽  
Skeletally Immature ◽  
Recurrent Instability ◽  
Femoral Fixation

Background: Given the proximity of the medial patellofemoral ligament (MPFL) femoral insertion to the distal femoral physis in skeletally immature patients, multiple techniques for femoral graft fixation have been described. Purpose: To systematically review the literature and evaluate outcomes and complications following MPFL reconstruction in skeletally immature patients. Study Design: Systematic review; Level of evidence, 4. Methods: A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines through use of the PubMed, Embase, and Cochrane Central databases. All original, English-language studies reporting outcomes or complications following MPFL reconstruction in skeletally immature patients were included. Skeletally mature patients were excluded. Data regarding demographics, surgical technique, graft type, outcomes, and complications were recorded. Study quality was assessed by use of the modified Coleman methodology score. Statistical analysis was performed through use of chi-square and weighted mean pooled cohort statistics, where appropriate, with significance set at P < .05. Results: 7 studies that entailed 132 MPFL reconstructions (126 patients) met the inclusion criteria. Females comprised 57.9% of the cohort (73 females), and the mean age was 13.2 years (range, 6-17 years). Mean postoperative follow-up was 4.8 years (range, 1.4-10 years). All of the grafts used were autograft, with gracilis tendon (n = 80; 60.6%) being the most common. Methods of femoral fixation included interference screw (n = 52; 39.4%), suture anchor (n = 51; 38.6%), and soft tissue pulley around the medial collateral ligament or adductor tendon (n = 29; 21.9%). Pooled Kujala scores improved from 59.1 to 84.6 after MPFL reconstruction. The total reported complication rate was 25.0% (n = 33) and included 5 redislocations (3.8%) and 15 subluxation events (11.4%). No cases of premature physeal closure were noted, and there were 3 reports of donor site pain (2.3%). Neither autograft choice ( P > .804) nor method of femoral fixation ( P > .416) influenced recurrent instability or overall complication rates. Conclusion: These findings suggest that MPFL reconstruction in skeletally immature patients is a viable treatment option, with significant improvement in patient-reported outcomes and redislocation event rates of less than 5% at nearly 5-year follow-up. Further high-quality research is needed to determine optimal graft options and surgical technique while considering recurrent instability, donor site morbidity, and potential injury to the adjacent physis.

Anchor-Based Femoral Fixation for Physeal-Sparing Medial Patellofemoral Ligament Reconstruction: A Time-Zero Biomechanical Comparison With Tenodesis Screw Fixation

2020 ◽  
Vol 48 (12) ◽  
pp. 3021-3027
Author(s):  
Tyler Robert Johnston ◽  
Jordan Liles ◽  
Jonathan Riboh
Keyword(s):  
Repeated Measures ◽  
Medial Patellofemoral Ligament ◽  
Failure Load ◽  
Screw Fixation ◽  
Group Versus ◽  
Femoral Fixation ◽  
Significance Level ◽  
Time Zero ◽  
Significant Difference ◽  
N Loading

Background: Open physes and trochlear/notch geometries in pediatric patients limit the safe corridor for femoral interference screw graft fixation during medial patellofemoral ligament (MPFL) reconstruction. Accordingly, interest is increasing in anchor-based fixation, but biomechanical validation is deficient. Purpose: To compare anchor-based and tenodesis screw femoral fixation of MPFL grafts in a time-zero biomechanical model. Study Design: Controlled laboratory study. Methods: Twenty-seven fresh-frozen porcine distal femurs were potted for testing in an electromechanical load frame, while bovine tendons were used for MPFL grafts. Reconstructions were performed with 1 of 3 femoral fixation strategies: 4.5-mm biocomposite double-loaded threaded anchor (DLA group), 3.9-mm biocomposite knotless threaded anchor (KA group), or traditional 7 × 23–mm biocomposite tenodesis screw (TS group). For testing, femoral specimens were oriented and secured in the mechanical testing apparatus such that actuator tensile pull re-created the normal MPFL trajectory. Specimens underwent 10 cycles of 5- to 15-N loading at 1-Hz preconditioning, followed by 1000 cycles of 10- to 50 N-loading at 1 Hz. After cyclic loading, all specimens were loaded to failure at 305 mm/min. The average cyclic construct stiffness, displacement, and load-to-failure data between the 3 groups were compared using analysis of variance (ANOVA) with the significance level set at P < .05. Results: Average cyclic construct stiffnesses were comparable across groups per repeated-measures ANOVA analysis: 68.3 ± 6.3, 71.4 ± 6.4, and 74.3 ± 7.9 N/mm for TS, DLA, and KA groups, respectively (at cycle 1000). Average construct displacements at cycles 100 and 1000 were significantly less in the anchor versus tenodesis screw groups per ANOVA and Tukey post hoc analysis: 7.7 ± 4.2 mm for the TS group versus 3.7 ± 0.4 and 4.3 ± 0.6 mm for the DLA and KA groups, respectively (at cycle 1000). There was no significant difference in ultimate failure loads between the anchor and tenodesis screw groups, but 3 of 9 TS constructs failed at loads below the average failure load of the native MPFL. Conclusion: Compared with the tenodesis group, anchor-based fixation produced constructs with equivalent cyclic stiffnesses, improved load-displacement characteristics, and had less failure load variability in the porcine cadaveric model. Clinical Relevance: Femoral fixation of the MPFL graft with a single anchor (4.5 or 3.9 mm threaded) is a viable alternative to traditional tenodesis screw fixation.

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

2020 ◽  
Author(s):  
Jae Ik Lee ◽  
Mohd Shahrul Azuan Jaffar ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
International Knee Documentation Committee ◽  
Predisposing Factors ◽  
Mpfl Reconstruction ◽  
Patellar Tilt ◽  
Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

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