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Biomechanical evaluation of three patellar fixation techniques for MPFL reconstruction: Load to failure did not differ but interference screw stabilization was stiffer than suture anchor and suture-knot fixation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare the maximum load to failure and stiffness of three medial patella-femoral ligament (MPFL) reconstruction techniques: (i) suture anchor fixation (SA), (ii) interference screw fixation (SF), and (iii) suture knot (SK) patellar fixation. The null hypothesis was that the comparison between these three different patella fixation techniques would show no difference in the ultimate failure load and stiffness.

Methods

Reconstruction of the MPFL with gracilis tendon autograft was performed in 12 pairs of fresh-frozen cadaveric knees (24 knees total; mean age, 63.6 \(\pm \) 8.0 years). The specimens were randomly distributed into 3 groups of 8 specimens; SA reconstruction was completed with two 3.0-mm metal suture anchors; (SF) fixation was accomplished by two 6-mm bio-composite interference screws; SK fixation at the lateral side of the patella was accomplished after drilling two semi-patellar tunnels with a diameter of 4.5 mm. The reconstructions were subjected to cyclic loading for 10 cycles to 30 N and tested to failure at a constant displacement rate of 15 mm/min using a materials-testing machine (MTS 810 Universal Testing System). The final load of failure (N), stiffness (N / mm) and failure mode was recorded in each specimen and followed by statistical analysis.

Results

There was no significant difference in mean ultimate failure load among the three groups. The SK group failed at a mean (\(\pm \) SD) ultimate load of 253.5 \(\pm \) 38.2 N, the SA group failed at 243 \(\pm \) 41.9 N and the SF group at 263.2 \(\pm \) 9.06 N. The SF group had a mean stiffness of 37.8 \(\pm \) 5.7 N/mm. This was significantly higher (p < 0.05) than the mean stiffness value achieved for the SK group 21.4 \(\pm \) 9.5 N/mm and the SA group 18.7 \(\pm \) 3.4 N/mm. The most common mode of failure in the SA group was anchor pullout, and in the SK group was failure at the graft–suture interface. All the reconstructions in the SF group failed due to tendon graft slippage from the tunnel.

Conclusion

Load to failure was not significantly different between the 3 techniques. However, screw fixation was found to be significantly stronger than the anchor and the suture knot fixation in terms of rigidity of the reconstruction. From a clinical point of view, all methods of fixation can be used reliably for MPFL reconstruction, since they were found to be stronger than the native MPFL.

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Acknowledgements

The authors would like to acknowledge H. Kapsouris, Mathematician, for his help regarding graphic design, and Stryker Company for donating anchors and bio-composite screws.

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Authors and Affiliations

  1. Anatomy Laboratory, Faculty of Medicine, University of Thessaly, Larissa, Greece

    Vasilios A. Raoulis, Aristidis Zibis & Konstantinos Banios

  2. Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, 41110, Larissa, Greece

    Vasilios A. Raoulis & Michael E. Hantes

  3. Laboratory of Mechanics and Strength of Materials, Department of Mechanical Engineering, University of Thessaly Volos, Volos, Greece

    Maria Dimitra Chiotelli & Alexis T. Kermanidis

  4. Centre of Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany

    Philipp Schuster

  5. Department of Orthopedics and Traumatology, Paracelsus Medical Private University, Clinic Nuremberg, Nuremberg, Germany

    Philipp Schuster

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  1. Vasilios A. Raoulis
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  2. Aristidis Zibis
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  7. Michael E. Hantes
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Corresponding author

Correspondence to Michael E. Hantes.

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Funding

This study and all authors have received no funding.

Conflict of interest

Author Vasilios A. Raoulis, Author Aristidis Zibis, Author Maria Dimitra Chiotelli, Author Alexis T. Kermanidis, Author Konstantinos Banios, Author Philipp Schuster and Author Michael Hantes, declare that they have no conflict of interest.

Ethical approval

This study was approved by IRB (Institutional Review Board) of the Medical School of University of Thessaly as part of the PhD thesis of one of the authors (ID number 2754).

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Raoulis, V.A., Zibis, A., Chiotelli, M.D. et al. Biomechanical evaluation of three patellar fixation techniques for MPFL reconstruction: Load to failure did not differ but interference screw stabilization was stiffer than suture anchor and suture-knot fixation. Knee Surg Sports Traumatol Arthrosc 29, 3697–3705 (2021). https://doi.org/10.1007/s00167-020-06389-4

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