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Isolated MPTL reconstruction fails to restore lateral patellar stability when compared to MPFL reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To biomechanically evaluate MPTL reconstruction and compare it with two techniques for MPFL reconstruction in regard to changes in patellofemoral contact pressures and restoration of patellar stability.

Methods

This is an experimental laboratory study in eight human cadaveric knees. None had patellofemoral cartilage lesions or trochlear dysplasia as evaluated by conventional radiographs and MRI examinations. The specimens were secured in a testing apparatus, and the quadriceps was tensioned in line with the femoral shaft. Contact pressures were measured using the TekScan sensor at 30°, 60° and 90°. The sensor was placed in the patellofemoral joint through a proximal approach between femoral shaft and quadriceps tendon to not violate the medial and lateral patellofemoral complex. TekScan data were analysed to determine mean contact pressures on the medial and lateral patellar facets. Patellar lateral displacement was evaluated with the knee positioned at 30° of flexion and 9 N of quadriceps load, then a lateral force of 22 N was applied. The same protocol was used for each condition: native, medial patellofemoral complex lesion, medial patellofemoral ligament reconstruction (MPFL-R) using gracilis tendon, MPFL-R using quadriceps tendon transfer, and medial patellotibial ligament reconstruction (MPTL-R) using patellar tendon transfer.

Results

No statistical differences were found for mean and peak contact pressures, medial or lateral, among all three techniques. However, while both techniques of MPFL-R were able to restore the medial restraint, MPTL-R failed to restore resistance to lateral patellar translation to the native state (mean lateralization of the patella [mm]: native: 9.4; lesion: 22; gracilis MPFL-R: 8.1; quadriceps MPFL-R: 11.3; MPTL-R: 23.4 (p < 0.001).

Conclusion

MPTL-R and both techniques for MPFL-R did not increase patellofemoral contact pressures; however, MPTL-R failed to provide a sufficient restraint against lateral patellar translation lateral translation in 30° of flexion. It, therefore, cannot be recommended as an isolated procedure for the treatment of patellar instability.

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Acknowledgements

Luiz Felipe Ambra was supported by Coordination for the Improvement of Higher Education Personnel (CAPES) of Brazil.

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Authors and Affiliations

  1. Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715 – 1o.andar, Vila Clementino, São Paulo, Brazil

    Luiz Felipe Ambra, Carlos Eduardo Franciozi & Flavio Faloppa

  2. Center for Regenerative Medicine and Cartilage Repair Center, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, USA

    Luiz Felipe Ambra & Amy Phan

  3. Knee Institute, Hospital do Coração, São Paulo, SP, Brazil

    Carlos Eduardo Franciozi

  4. Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

    Carlos Eduardo Franciozi

  5. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Andreas H. Gomoll

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  1. Luiz Felipe Ambra
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  2. Carlos Eduardo Franciozi
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  3. Amy Phan
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  4. Flavio Faloppa
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  5. Andreas H. Gomoll
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Correspondence to Luiz Felipe Ambra.

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IRB approval by Partners Human Research Committee Protocol # 2016P000021/BWH.

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Ambra, L.F., Franciozi, C.E., Phan, A. et al. Isolated MPTL reconstruction fails to restore lateral patellar stability when compared to MPFL reconstruction. Knee Surg Sports Traumatol Arthrosc 29, 793–799 (2021). https://doi.org/10.1007/s00167-020-06015-3

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  • DOI: https://doi.org/10.1007/s00167-020-06015-3

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