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Application of a true lateral virtual radiograph from 3D-CT to identify the femoral reference point of the medial patellofemoral ligament

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study is two-fold: (1) to describe the femoral reference point of the medial patellofemoral ligament (MPFL) on a virtual true lateral radiograph reconstructed from a three-dimensional computed tomography (3D-CT) image and (2) to compare this point with that of patients without patellofemoral instability and with Schöttle’s point.

Methods

A total of 26 consecutive patients (29 affected knees) with recurrent patellar dislocation (RPD), who underwent MPFL reconstruction were included in this study (4 males; 22 females; mean age, 24.0 years old). Using a true lateral 3DCT image, the MPFL femoral insertion was identified and marked with a 2-mm circle, and this image was reconstructed as a virtual true lateral radiograph. Following Schöttle’s method, the point of intersection was described by their anterior–posterior and proximal–distal positions. As a control population, 29 age- and gender-matched patients with anterior cruciate ligament (ACL) injuries were also analysed.

Results

The points in RPD patients were located significantly posterior (-2.5 ± 2.3 mm, p < 0.01) to the line representing an extension of the posterior cortex of the femur and distal (− 6.9 ± 2.4 mm, p < 0.01) to the posterior origin of the medial femoral condyle compared with those in the control population. The mean reference point of RPD patients was located in a 3.8-mm posterior and 4.4-mm distal position compared with Schöttle’s point.

Conclusions

An anatomical and radiographic femoral reference point of the MPFL on a true lateral virtual radiograph was described with our method. In patients with RPD, this reference point was identified to be more posterior and distal to Schöttle’s point. More anatomical and individualized MPFL reconstruction will be secured using our method.

Level of evidence

Level IV.

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Acknowledgements

The authors would like to thank Editage (www.editage.com) for English language editing.

Funding

No funding was received for the development of this manuscript.

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Authors and Affiliations

Authors

Contributions

Masakazu Ishikawa: conception and design, acquisition and analysis of data, drafting the article. Charles Hoo: analysis and interpretation of data, drafting the article. Minoru Ishifuro: image reconstruction. Goki Kamei: analysis and interpretation of data. Takenori Omoto: acquisition of data. Toshiya Kano: acquisition of data. Kyohei Nakata: acquisition of data. Akinori Nekomoto: acquisition of data. Atsuo Nakamae: analysis and interpretation of data. Nobuo Adachi: final approval of the manuscript.

Corresponding author

Correspondence to Masakazu Ishikawa.

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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We obtained institutional review board approval for this retrospective case series study (E-1160).

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All study participants provided informed consent.

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Ishikawa, M., Hoo, C., Ishifuro, M. et al. Application of a true lateral virtual radiograph from 3D-CT to identify the femoral reference point of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 29, 3809–3817 (2021). https://doi.org/10.1007/s00167-020-06403-9

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