Graft length change and radiographic assessment of femoral drill hole position for medial patellofemoral ligament reconstruction

  • Tomohiko Tateishi
  • Masamitsu Tsuchiya
  • Naoya Motosugi
  • Shintaro Asahina
  • Hiroo Ikeda
  • Sadahiro Cho
  • Takeshi MunetaEmail author



Medial patellofemoral ligament (MPFL) reconstruction has been recognized as a useful treatment method for patella instability. However, the optimal fixation site has not been well investigated, and few reports have examined intraoperative graft length change. The purpose of the study is to evaluate the intraoperative graft length change and femoral drill hole position to find the optimal graft placement.


The graft length change between the two points on patella and femur was measured using Isotac® and Isometric Positioner® during passive knee motion in 27 cases of MPFL. The location of Isotac® was also evaluated on the 2-directional radiograph. The pre- and postoperative radiographic assessments have been done in order to evaluate the effect of MPFL reconstruction on patellofemoral alignment.


There were 10 cases in which the distance between the two points became longer during knee flexion, 8 cases in which it became shorter and the remaining 9 cases in which the distance changed within 2 mm. The femoral drill hole position was assessed assuming that the maximum anterior-posterior (AP) diameter of the femur on the lateral radiograph was defined as 100%. The distance of the femoral tunnel position from the articular surface averaged 50% overall, 46% in the short group, 55% in the longer group and 48% in the isometric group (P < 0.001). Patella height seemingly affected the length change character. The intraoperative length change influenced the early recovery of knee range motion postoperatively.


The femoral tunnel position is reaffirmed to be an essential determinant for the graft length change in the MPFL reconstruction. Both graft length change measurements and intraoperative radiographic assessment are practical for proper graft placement.


Medial patellofemoral ligament (MPFL) Reconstruction Graft isometry Intraoperative radiographic evaluation Postoperative knee flexion 


  1. 1.
    Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220CrossRefPubMedGoogle Scholar
  2. 2.
    Aragão JA, Reis FP, de Vasconcelos DP, Feitosa VL, Nunes MA (2008) Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadavers. Clinics 63:541–544CrossRefPubMedGoogle Scholar
  3. 3.
    Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft tissue restraint of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693PubMedGoogle Scholar
  4. 4.
    Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65PubMedGoogle Scholar
  5. 5.
    Feller JA, Feagin JA Jr, Garrett WE Jr (1993) The medial patellofemoral ligament revisited: an anatomical study. Knee Surg Sports Traumatol Arthrosc 1:184–186CrossRefPubMedGoogle Scholar
  6. 6.
    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 349:174–182CrossRefPubMedGoogle Scholar
  7. 7.
    Nomura E, Inoue M, Osada N (2005) Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 13:510–515CrossRefPubMedGoogle Scholar
  8. 8.
    Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10:221–227CrossRefPubMedGoogle Scholar
  9. 9.
    Steensen RN, Dopirak RM, McDonald WG 3rd (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32:1509–1513CrossRefPubMedGoogle Scholar
  10. 10.
    Triantafillopoulos IK, Panagopoulos A, van Niekerk L (2007) Isometric behavior of the reconstructed medial patellofemoral ligament using two different femoral pulleys: a cadaveric study. Med Sci Monit 13:181–187Google Scholar
  11. 11.
    Tuxøe JI, Teir M, Winge S, Nielsen PL (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10:138–140CrossRefPubMedGoogle Scholar
  12. 12.
    Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M (2005) A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13:522–528CrossRefPubMedGoogle Scholar
  13. 13.
    Ellera Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8:335–340CrossRefPubMedGoogle Scholar
  14. 14.
    Nomura E, Horiuchi Y, Kihara M (2000) A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 7:211–215CrossRefPubMedGoogle Scholar
  15. 15.
    Suganuma J, Mitani T, Suzuki N (1989) Reconstruction of the medial patellofemoral ligament. Trans Tokyo Knee Soc (in Japanese) 10:137–148Google Scholar
  16. 16.
    Ellera Gomes JL, Stigler Marczyk LR, César de César P, Jungblut CF (2004) Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study. Arthroscopy 20:147–151CrossRefPubMedGoogle Scholar
  17. 17.
    Nomura E, Inoue M, Kobayashi S (2007) Long-term follow-up and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 35:1851–1858CrossRefPubMedGoogle Scholar
  18. 18.
    Cox JS (1976) An evaluation of the Elmslie-Trillat procedure for management of patellar dislocations and subluxations: a preliminary report. Am J Sports Med 4:72–77CrossRefPubMedGoogle Scholar
  19. 19.
    Muneta T, Sekiya I, Tsuchiya M, Shinomiya K (1999) A technique for reconstruction of the medial patellofemoral ligament. Clin Orthop Relate Res 359:151–155CrossRefGoogle Scholar
  20. 20.
    Morgan CD, Kalmam VR, Grawl DM (1995) Isometry testing for anterior cruciate ligament reconstruction revisited. Arthroscopy 11:647–659CrossRefPubMedGoogle Scholar
  21. 21.
    Schöttle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35:801–804CrossRefPubMedGoogle Scholar
  22. 22.
    Insall J, Goldberg V, Salvati E (1972) Recurrent dislocation and the high-riding patella. Clin Orthop Relat Res 88:67–69CrossRefPubMedGoogle Scholar
  23. 23.
    Laurin CA, Dussault R, Levesque HP (1979) The tangential x-ray investigation of the patellofemoral joint: X-ray technique, diagnostic criteria and their interpretation. Clin Orthop Relat Res 144:16–26PubMedGoogle Scholar
  24. 24.
    Merchant AC, Mercer RL, Lacobsen RH, Cool CR (1974) Roentgenographic analysis of patello-femoral congruence. J Bone Joint Surg Am 56:1391–1396PubMedGoogle Scholar
  25. 25.
    Fulkerson JP (1997) Imaging the patellofemoral joint. In: Fulkerson JP (ed) Disorders of the patellofemoral joint, 3rd edn. Williams & Wilkins, Baltimore, pp 86–87Google Scholar
  26. 26.
    Baumgartl F (1944) Das Kniegelenk. Splinger Verlag, BerlinGoogle Scholar
  27. 27.
    Wiberg G (1941) Roentgenographic and anatomic studies on the femoro-patellar joint. Acta Orthop Scand 2:319–410Google Scholar
  28. 28.
    Elias JJ, Cosgarea AJ (2006) Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 34:1478–1485CrossRefPubMedGoogle Scholar
  29. 29.
    Melegari TM, Parks BG, Matthews LS (2008) Patellofemoral contact area and pressure after medial patellofemoral ligament reconstruction. Am J Sports Med 36:747–752CrossRefPubMedGoogle Scholar
  30. 30.
    Ostermeier S, Holst M, Bohnsack M, Hurschler C, Stukenborg-Colsman C, Wirth CJ (2007) Dynamic measurement of patellofemoral contact pressure following reconstruction of the medial patellofemoral ligament: an in vitro study. Clin Biomech (Bristol, Avon) 22:327–335CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Tomohiko Tateishi
    • 1
    • 3
  • Masamitsu Tsuchiya
    • 1
  • Naoya Motosugi
    • 1
  • Shintaro Asahina
    • 1
  • Hiroo Ikeda
    • 2
  • Sadahiro Cho
    • 2
  • Takeshi Muneta
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryDoai Memorial HospitalTokyoJapan
  2. 2.Department of Orthopaedic SurgeryKawaguchi Kohgyo General HospitalSaitamaJapan
  3. 3.Section of Orthopedic Surgery, Graduate School of MedicineTokyo Medical and Dental UniversityTokyoJapan

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