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Soft-tissue fixation is not inferior to suture-anchor fixation in reconstruction of the medial patellofemoral ligament using a nonresorbable suture tape

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Reconstruction of the medial patellofemoral ligament (MPFL-R) with nonresorbable suture tape (FiberTape®, FT) is becoming popular. Patella-side fixation of the FT can be performed with suture anchors or via soft-tissue fixation. The aim of this study was to investigate whether patella-side soft-tissue fixation can achieve equivalent primary stability compared to suture-anchor fixation.

Methods

In ten human, fresh-frozen knee joint specimens (m/f 6/4; age 74 ± 9 a), the MPFL was identified and dissected near the femoral insertion site. In five knee joints, the MPFL-R using FT was performed with soft-tissue fixation at the patella (study group; SG), and in five knee joints, the FT was fixed via suture anchors (control group, CG). All reconstructions were evaluated until load to failure of the patella-side fixation with a displacement rate of 200 mm/min.

Results

The mean maximum load to failure in the SG was 395.3 ± 57.9 N. All reconstructions failed by complete tearing off the medial patellar retinaculum from its medial patellar margin, but fixation of the FT remained stable. In the CG, the mean maximum load to failure was 239.4 ± 54.5 N and was significantly different compared to the SG (p = 0.04). All reconstructions failed via pullout of the suture anchors. Stiffness and elongation did not differ between the groups, and no failure of the FT was observed in any of the specimens.

Conclusion

Primary stability of soft-tissue MPFL-R using FT was superior to suture-anchor fixation. Both fixation techniques provided sufficient primary stability, superior to previously reported native MPFL tensile strengths. MPFL-R with FT could be a possible alternative procedure for MPFL-R, eliminating potential complications due to autologous tendon graft harvesting.

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Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik Ludwigshafen, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Germany

    Felix Zimmermann, Jochen Franke, Paul Alfred Grützner & Sven Vetter

  2. Arcus Sportklinik, Pforzheim, Germany

    Peter Balcarek

  3. Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medicine Göttingen, Göttingen, Germany

    Peter Balcarek

  4. Labor für biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Heidelberg, Germany

    Mareike Schonhoff & Sebastian Jäger

  5. Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus Mitte, Berlin, Germany

    Danko Dan Milinkovic

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  1. Felix Zimmermann
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Contributions

FZ: Study design, data acquisition, data analysis, data interpretation, writing the paper, final approval. MS: Data acquisition, data analysis, final approval. SJ: Data acquisition, data analysis, final approval. DM: Data analysis, data interpretation, final approval. JF: Data analysis, data interpretation, final approval. PAG: Data analysis, data interpretation, final approval. PB: Study design, data analysis, data interpretation, writing the paper, final approval. SV: Study design, data acquisition, data analysis, data interpretation, writing the paper, final approval.

Corresponding author

Correspondence to Sven Vetter.

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Conflict of interest

PB, MS, and DDM declare that they have no competing interests. FZ, PAG, JF, and SV are members of the MINTOS research group, who had grants/grants pending and technical support from Siemens Healthineers (Erlangen, Germany) and Nuvasive (SanDiego, USA). PAG and JF are unpaid members of an advisory board for Siemens. SJ receives research support from a company or supplier as a principal investigator: Johnson & Johnson DePuy, B. Braun Aesculap, Waldemar Link, Heraeus Medical, Zimmer Biomet, Peter Brehm GmbH, Ceramtec, Implantcast, Medacta, Mathys, Tornier. No company had involvement in the study design, collection, analysis, and interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication.

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Ethics approval was given by the local ethics committee (Reference no. 2021-15764_1-andere Forschung erstvotierend).

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Zimmermann, F., Schonhoff, M., Jäger, S. et al. Soft-tissue fixation is not inferior to suture-anchor fixation in reconstruction of the medial patellofemoral ligament using a nonresorbable suture tape. Knee Surg Sports Traumatol Arthrosc 31, 292–298 (2023). https://doi.org/10.1007/s00167-022-07120-1

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