Abstract
Background
Several MPFL reconstructions are commonly performed for recurrent patellar dislocation, but misleading data are currently available in the literature on the ability of the different techniques to re-create a functioning ligament.
Materials and methods
In this study, we showed the biomechanical properties of two different procedures for MPFL reconstruction using a natural orientation during uniaxial tensile testing. Eighteen fresh-frozen human knees were randomly assigned to two groups of nine each. In the group A, the reconstruction was performed using a double converging tunnels technique and in the group B was used a single-tunnel technique with semitendinosus autograft. The specimens were loaded in natural orientation using an Instron tensile test machine, and the stiffness and ultimate load were determined.
Results
The ultimate load was 213 ± 90 and 171 ± 51 N using our double-bundle technique (group A) and the single-bundle technique (group B), respectively. One (11 %) specimen failed at the patellar side due to patellar fracture in the group B. There was no statistical significant difference (p > 0.05) between the two groups in terms of stiffness and ultimate load.
Conclusion
This study is the first biomechanical evaluation of the MPFL reconstructions in natural orientation. Both the procedures achieved safe fixation of the graft at the femoral attachment; however, the single-bundle technique reported 11 % of failure at the patellar side due to patellar fracture. In addition, the double-bundle technique can better restore the anatomy of the native ligament.
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References
Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M (2005) A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13(7):522–528. doi:10.1007/s00167-005-0641-x
Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11(1):24–31
Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23(5):260–263
Sally PIPJ, Speer KP et al (1996) Acute dislocation of the patella: a correlative pathoanatomical study. Am J Sport Med 24:52–60
Dandy DJ (1996) Chronic patellofemoral instability. J Bone Joint Surg Br 78(2):328–335
Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 349:174–182
Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75(5):682–693
Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220
Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65
Nomura E, Inoue M, Osada N (2005) Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 13(7):510–515. doi:10.1007/s00167-004-0607-4
Placella G, Tei M, Sebastiani E, Speziali A, Antinolfi P, Delcogliano M, Georgoulis A, Cerulli G (2015) Anatomy of the Medial Patello-Femoral Ligament: a systematic review of the last 20 years literature. Musculoskelet Surg 99(2):93–103. doi:10.1007/s12306-014-0335-y
Nomura E, Inoue M (2003) Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Arthrosc J Arthrosc Relat Surg 19(5):E47. doi:10.1053/jars.2003.50167
Placella G, Tei MM, Sebastiani E, Criscenti G, Speziali A, Mazzola C, Georgoulis A, Cerulli G (2014) Shape and size of the medial patellofemoral ligament for the best surgical reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc 22(10):2327–2333. doi:10.1007/s00167-014-3207-y
Beck P, Brown NA, Greis PE, Burks RT (2007) Patellofemoral contact pressures and lateral patellar translation after medial patellofemoral ligament reconstruction. Am J Sports Med 35(9):1557–1563. doi:10.1177/0363546507300872
Elias JJ, Cosgarea AJ (2006) Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 34(9):1478–1485. doi:10.1177/0363546506287486
Kim KE, Hsu SL, Woo SL (2014) Tensile properties of the medial patellofemoral ligament: the effect of specimen orientation. J Biomech 47(2):592–595. doi:10.1016/j.jbiomech.2013.11.026
Criscenti G, De Maria C, Sebastiani E, Tei M, Placella G, Speziali A, Vozzi G, Cerulli G (2015) Material and structural tensile properties of the human medial patello-femoral ligament. J Mech Behav Biomed Mater 54:141–148. doi:10.1016/j.jmbbm.2015.09.030
Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10(3):221–227
Mountney J, Senavongse W, Amis AA, Thomas NP (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br 87(1):36–40
Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S (1991) Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med 19(3):217–225
Zamarra G, Fisher MB, Woo SL, Cerulli G (2010) Biomechanical evaluation of using one hamstrings tendon for ACL reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc 18(1):11–19. doi:10.1007/s00167-009-0911-0
Nelitz M, Dreyhaupt J, Reichel H, Woelfle J, Lippacher S (2013) Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents with open growth plates: surgical technique and clinical outcome. Am J Sports Med 41(1):58–63. doi:10.1177/0363546512463683
Wang CH, Ma LF, Zhou JW, Ji G, Wang HY, Wang F, Wang J (2013) Double-bundle anatomical versus single-bundle isometric medial patellofemoral ligament reconstruction for patellar dislocation. Int Orthop 37(4):617–624. doi:10.1007/s00264-013-1788-6
Deie M, Ochi M, Sumen Y, Yasumoto M, Kobayashi K, Kimura H (2003) Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg Br 85(6):887–890
Schottle PB, Fucentese SF, Romero J (2005) Clinical and radiological outcome of medial patellofemoral ligament reconstruction with a semitendinosus autograft for patella instability. Knee Surg Sports Traumatol Arthrosc 13(7):516–521. doi:10.1007/s00167-005-0659-0
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Placella, G., Speziali, A., Sebastiani, E. et al. Biomechanical evaluation of medial patello-femoral ligament reconstruction: comparison between a double-bundle converging tunnels technique versus a single-bundle technique. Musculoskelet Surg 100, 103–107 (2016). https://doi.org/10.1007/s12306-016-0397-0
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DOI: https://doi.org/10.1007/s12306-016-0397-0