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Isolated medial patellofemoral ligament reconstruction for patella instability is insufficient for higher degrees of internal femoral torsion

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A medial patellofemoral ligament reconstruction (MPFL) with an additional derotational femoral osteotomy is suggested for patients suffering from patellar instability and an increased internal femoral torsion (IT). This biomechanical study investigated whether an isolated MPFL reconstruction could restore patellofemoral biomechanics for 10° and 20° relatively increased internal femoral torsion.

Methods

Eight fresh-frozen cadaver knees were tested on a specially designed knee simulator, which bend the knee from 0° to 90° flexion. Patellar motion (tilt and shift) and patellofemoral pressure (pressure shift, mean and peak pressure) were evaluated for 0°, 10° and 20° of IT with a native and reconstructed MPFL.

Results

An isolated MPFL reconstruction, compared to a native MPFL with the same femoral torsion showed a significant medial shift of the center of force (10° IT p < 0.001; 20° IT p = 0.02) and patella shift (10° and 20° IT p < 0.001) but no significant change in patella tilt (10° IT n.s.; 20° IT n.s.) for 10° and 20° IT. There was a significant medial shift in the center of force for 10° IT (10° IT p = 0.04) and a non-significant lateral shift for 20° IT (20° IT n.s.) in comparison to the native MPFL with 0° of femoral torsion. Patella shift was directed medially for 10° IT (10° IT p = 0.002). In knee flexion angles up to 30°, the patella remained more lateral for 20° IT and showed a different motion pattern (20° IT n.s.). Patella tilt showed a significant lateral tilt for 10° and 20° IT (10° IT p = 0.01; 20° IT p = 0.002).

Conclusion

MPFL reconstruction as an isolated therapy only appears to be reasonable for 10° increased IT. While for an increased IT of 20°, a lateralizing force vector remains and an additional femoral derotational osteotomy is recommendable. These findings may assist surgeons in the decision making of surgical procedures in patients suffering from patella instability.

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Abbreviations

IT:

Internal femoral torsion

MPFL:

Medial patellofemoral ligament

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Authors and Affiliations

  1. Department for Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria

    P. Kaiser, W. Schmoelz & Ch. Heinrichs

  2. Knee and Hip Institute Munich, Munich, Germany

    P. B. Schöttle

  3. Department for Anatomy, Embryology and Histology, Medical University of Innsbruck, Innsbruck, Austria

    M. Zwierzina

  4. Department for Trauma Surgery and Sports Medicine, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria

    R. Attal

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  1. P. Kaiser
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  3. P. B. Schöttle
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  4. Ch. Heinrichs
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  5. M. Zwierzina
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  6. R. Attal
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All authors stated on the manuscript were fully involved in evaluating the study and writing the manuscript.

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Correspondence to R. Attal.

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Kaiser, P., Schmoelz, W., Schöttle, P.B. et al. Isolated medial patellofemoral ligament reconstruction for patella instability is insufficient for higher degrees of internal femoral torsion. Knee Surg Sports Traumatol Arthrosc 27, 758–765 (2019). https://doi.org/10.1007/s00167-018-5065-5

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  • DOI: https://doi.org/10.1007/s00167-018-5065-5

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