Abstract
Purpose
To correlate the location of the medial patellofemoral ligament femoral fixation site in knees suffering a chronic lateral patellar instability, by using radiographic references and by using the most important anatomic reference point (i.e. the adductor tubercle) identified by means of 3-dimensional (3D) surface reconstructions by computed tomography (CT) imaging.
Methods
Thirty consecutive knee 3D-CT examinations at 0º of knee extension were obtained from patients (20 females, 10 males; median age of 23.5 years; range, 14–48 years) treated for chronic lateral patellar instability with at least two documented patellar dislocations. For each knee, three virtual 7-mm-diameter femoral tunnels were created. One of the tunnels used an anatomic fixation landmark (anatomic fixation), while the other two used established radiologic methods. We calculated the percentage of the anatomic tunnel covered by the tunnel created according to the method described by Schoettle, and the percentage of the anatomic tunnel covered by the tunnel created according to the method described by Stephen. These percentages were compared using paired Student’s t test.
Results
The percentage of anatomic tunnel area covered by the femoral tunnel created using Schoettle’s method was 36.7 ± 25.2 %. When using Stephen’s method, the percentage of overlap with the anatomic femoral tunnel was 25.5 ± 21.5 %. There were no significant differences between the two radiographic methods (n.s.).
Conclusion
None of the standard radiographic methods allowed a precise anatomic femoral placement. Conventional radiographic identification of the femoral graft placement site is only an approximation and should not be the sole basis for femoral attachment location.
Level of evidence
IV
Similar content being viewed by others
References
Baldwin JL (2009) The anatomy of the medial patellofemoral ligament. Am J Sports Med 37(12):2355–2361
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26
Fujino K, Tajima G, Yan J, Kamei Y, Maruyama M, Takeda S, Kikuchi S, Shimamura T (2013) Morphology of the femoral insertion site of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2797-0
Kopf S, Forsythe B, Wong AK, Tashman S, Irrgang JJ, Fu FH (2012) Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc 20(11):2200–2207
LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The Anatomy of the Medial Part of the Knee. J Bone Joint Surg (Am) 89:2000–2010
Oka S, Matsushita T, Kubo S, Matsumoto T, Tajimi H, Kurosaka M, Kuroda R (2014) Simulation of the optimal femoral insertion site in medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 22(10):2364–2371
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
Sanchis-Alfonso V (2014) Guidelines for medial patellofemoral ligament reconstruction in chronic lateral patellar instability. J Am Acad Orthop Surg 22:175–182
Schoettle 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
Servien E, Fritsch B, Lustig S, Demey G, Debarge R, Lapra C, Neyret P (2011) In vivo positioning analysis of medial patellofemoral ligament reconstruction. Am J Sports Med 39(1):134–139
Siebold R, Borbon CA (2012) Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft-surgical technique. Knee Surg Sports Traumatol Arthrosc 20(7):1245–1251
Stephen JM, Lumpaopong P, Deehan DJ, Kader D, Amis AA (2012) The medial patellofemoral ligament: location of femoral attachment and length change patterns resulting from anatomic and nonanatomic attachments. Am J Sports Med 40(8):1871–1879
Tang J, Thorhauer E, Marsh C, Fu FH, Tashman S (2014) Knee rotation influences the femoral tunnel angle measurement after anterior cruciate ligament reconstruction: a 3-dimensional computed tomography model study. Knee Surg Sports Traumatol Arthrosc 22(7):1505–1510
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
Yoo YS, Chang HG, Seo YJ, Byun JC, Lee GK, Im H, Song SY (2012) Changes in the length of the medial patellofemoral ligament: an in vivo analysis using 3-dimensional computed tomography. Am J Sports Med 40(9):2142–2148
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sanchis-Alfonso, V., Ramirez-Fuentes, C., Montesinos-Berry, E. et al. Does radiographic location ensure precise anatomic location of the femoral fixation site in medial patellofemoral ligament surgery?. Knee Surg Sports Traumatol Arthrosc 24, 2838–2844 (2016). https://doi.org/10.1007/s00167-015-3523-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-015-3523-x