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Reliability of radiographic landmarks in medial patello-femoral ligament reconstruction in relation to the anatomical femoral torsion

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Abstract

Purpose

Anatomically correct graft positioning at the femoral insertion site is a key factor in surgical reconstruction of the medial patello-femoral ligament (MPFL). Basically there are two techniques to define this point in fluoroscopy during surgery. The role of the anatomical femoral torsion on the accuracy and reproducibility of both procedures has not been clarified.

Methods

Twenty human anatomical leg specimens were dissected. The femoral insertion of the MPFL was marked by two K-wires. The position of the ligament insertion was determined fluoroscopically in the true lateral view as used in routine clinical practice. The anatomical MPFL insertion was compared to the radiographic landmarks which were recommended by two previous studies. The anatomical femoral torsion of the specimens was assessed by computed tomography scans.

Results

In true lateral view fluoroscopy, the mean distance of the femoral MPFL insertion was −0.2 mm distal to the vertical reference line intersecting the posterior point of Blumensaat’s line. In the anteroposterior direction, the mean distance was −2.0 mm posterior to the femoral cortex reference line. There was no correlation between anatomical femoral torsion and the distance of the femoral MPFL insertion to the posterior cortex.

Conclusions

The results of this study strongly recommend use of a vertical line intersecting the most posterior point of Blumensaat’s line as a reference to identify the MPFL insertion in the craniocaudal direction. In the anteroposterior direction, the femoral MPFL insertion showed distinctive variation and was found −2.0 mm posterior to the femoral cortex reference line without being influenced by the anatomical femoral torsion.

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References

  1. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220

    Article  CAS  PubMed  Google Scholar 

  2. Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 349:174–182

    Article  PubMed  Google Scholar 

  3. Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7(2):121–127

    Article  PubMed  Google Scholar 

  4. Sandmeier RH, Burks RT, Bachus KN, Billings A (2000) The effect of reconstruction of the medial patellofemoral ligament on patellar tracking. Am J Sports Med 28(3):345–349

    CAS  PubMed  Google Scholar 

  5. de Oliveira V, de Souza V, Cury R, Camargo OP, Avanzi O, Severino N, Fucs P (2014) Medial patellofemoral ligament anatomy: is it a predisposing factor for lateral patellar dislocation? Int Orthop 38(8):1633–1639. doi:10.1007/s00264-014-2357-3

    Article  PubMed  Google Scholar 

  6. Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24(1):52–60

    Article  CAS  PubMed  Google Scholar 

  7. Hawkins RJ, Bell RH, Anisette G (1986) Acute patellar dislocations. The natural history. Am J Sports Med 14(2):117–120

    Article  CAS  PubMed  Google Scholar 

  8. Drez D Jr, Edwards TB, Williams CS (2001) Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 17(3):298–306. doi:10.1053/jars.2001.21490

    Article  PubMed  Google Scholar 

  9. Csintalan RP, Latt LD, Fornalski S, Raiszadeh K, Inacio MC, Fithian DC (2014) Medial patellofemoral ligament (MPFL) reconstruction for the treatment of patellofemoral instability. J Knee Surg 27(2):139–146. doi:10.1055/s-0033-1360652

    PubMed  Google Scholar 

  10. Fernandez E, Sala D, Castejon M (2005) Reconstruction of the medial patellofemoral ligament for patellar instability using a semitendinosus autograft. Acta Orthop Belg 71(3):303–308

    PubMed  Google Scholar 

  11. Wang CH, Ma LF, Zhou JW, Ji G, Wang HY, Wang F, Wang J (2013) Double-bundle anatomical versus single-bundle isometric medial patellofemoral ligament reconstruction for patellar dislocation. Int Orthop 37(4):617–624. doi:10.1007/s00264-013-1788-6

    Article  PubMed Central  PubMed  Google Scholar 

  12. Matthews JJ, Schranz P (2010) Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop 34(8):1321–1325. doi:10.1007/s00264-009-0918-7

    Article  PubMed Central  PubMed  Google Scholar 

  13. Ntagiopoulos PG, Sharma B, Bignozzi S, Lopomo N, Colle F, Zaffagnini S, Dejour D (2013) Are the tubular grafts in the femoral tunnel in an anatomical or isometric position in the reconstruction of medial patellofemoral ligament? Int Orthop 37(10):1933–1941. doi:10.1007/s00264-013-1938-x

    Article  PubMed Central  PubMed  Google Scholar 

  14. Nelitz M, Williams RS, Lippacher S, Reichel H, Dornacher D (2014) Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients. Int Orthop. doi:10.1007/s00264-014-2437-4

    PubMed  Google Scholar 

  15. Barnett AJ, Howells NR, Burston BJ, Ansari A, Clark D, Eldridge JD (2012) Radiographic landmarks for tunnel placement in reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 20(12):2380–2384. doi:10.1007/s00167-011-1871-8

    Article  CAS  PubMed  Google Scholar 

  16. Schöttle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35(5):801–804. doi:10.1177/0363546506296415

    Article  PubMed  Google Scholar 

  17. Abadie P, Galaud B, Michaut M, Fallet L, Boisrenoult P, Beaufils P (2009) Distal femur rotational alignment and patellar subluxation: a CT scan in vivo assessment. Orthop Traumatol Surg Res 95(4):267–271. doi:10.1016/j.otsr.2009.04.004

    Article  CAS  PubMed  Google Scholar 

  18. Diederichs G, Köhlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41(1):51–57. doi:10.1177/0363546512464691

    Article  PubMed  Google Scholar 

  19. Jend HH (1986) Computed tomographic determination of the anteversion angle. Premises and possibilities. Rofo 144(4):447–452. doi:10.1055/s-2008-1048820

    Article  CAS  PubMed  Google Scholar 

  20. Schneider B, Laubenberger J, Jemlich S, Groene K, Weber HM, Langer M (1997) Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging. Br J Radiol 70(834):575–579. doi:10.1259/bjr.70.834.9227249

    Article  CAS  PubMed  Google Scholar 

  21. Baldwin JL (2009) The anatomy of the medial patellofemoral ligament. Am J Sports Med 37(12):2355–2361. doi:10.1177/0363546509339909

    Article  PubMed  Google Scholar 

  22. Redfern J, Kamath G, Burks R (2010) Anatomical confirmation of the use of radiographic landmarks in medial patellofemoral ligament reconstruction. Am J Sports Med 38(2):293–297. doi:10.1177/0363546509347602

    Article  PubMed  Google Scholar 

  23. Wijdicks CA, Griffith CJ, LaPrade RF, Johansen S, Sunderland A, Arendt EA, Engebretsen L (2009) Radiographic identification of the primary medial knee structures. J Bone Joint Surg Am 91(3):521–529. doi:10.2106/JBJS.H.00909

    Article  PubMed  Google Scholar 

  24. Kaipel M, Gergely I, Sinz K, Neumann C, Sinz G (2013) Femoral rotation in ligament balanced knee arthroplasty: a prospective clinical study. J Arthroplasty 28(7):1103–1106. doi:10.1016/j.arth.2013.02.031

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors gratefully acknowledge Katrina Sinz for statistical support.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Traumatology, Barmherzige Brüder Hospital, Johannes von Gott Platz 1, 7000, Eisenstadt, Austria

    Martin Kaipel & Harald Boszotta

  2. Department of Traumatology, Trauma Centre Meidling, Kundratstraße 37, 1120, Vienna, Austria

    Sebastian Schützenberger

  3. Department of Paediatric Orthopaedics, Orthopaedic Hospital Speising, Speisinger Straße 109, 1130, Vienna, Austria

    Sebastian Farr

  4. Department of Radiology, Barmherzige Brüder Hospital, Esterhazystrasse 26, 7000, Eisenstadt, Austria

    Istvan Gergely

  5. Department of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Alexander Vlcek & Franz Kainberger

  6. Department for Applied Anatomy, Centre of Anatomy and Cell Biology, Medical University Vienna, Währingerstraße 13, 1090, Vienna, Austria

    Michael Pretterklieber

Authors
  1. Martin Kaipel
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  2. Sebastian Schützenberger
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  3. Sebastian Farr
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  4. Istvan Gergely
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  7. Harald Boszotta
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Correspondence to Martin Kaipel.

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Kaipel, M., Schützenberger, S., Farr, S. et al. Reliability of radiographic landmarks in medial patello-femoral ligament reconstruction in relation to the anatomical femoral torsion. International Orthopaedics (SICOT) 39, 423–428 (2015). https://doi.org/10.1007/s00264-014-2523-7

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  • DOI: https://doi.org/10.1007/s00264-014-2523-7

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