Troubleshooting the Femoral Attachment During Medial Patellofemoral Ligament Reconstruction: Location, Location, Location.
نویسندگان
چکیده
The medial patellofemoral ligament (MPFL) has been recognized as an important soft tissue restraint in preventing lateral patellar translation. As many patients with acute or chronic patellar instability will have a deficient MPFL, reconstruction of this ligament is becoming more common. Appropriately, significant research has been undertaken regarding graft biomechanics and techniques, as intraoperative errors in graft placement often result in poor patient outcomes. Although the research has not answered all of the dilemmas encountered during reconstruction, publications consistently emphasize the importance of re-establishing an anatomic femoral attachment. The purpose of this study was to briefly review the current literature on MPFL reconstruction. Graft selection and patellar graft attachment and fixation are discussed, but the main focus is the femoral attachment as this is where most errors are seen and, unfortunately, where getting it right appears to matter the most. Using a sawbones knee model, the concepts of an MPFL graft that is "high and tight" or "low and loose" are presented, with the goal of providing physicians with intraoperative tools to adjust an incorrectly placed femoral MPFL attachment. This model is also used to justify the recommendation of graft fixation in 30° to 45° of knee flexion.
منابع مشابه
Troubleshooting the Femoral Attachment During Medial Patellofemoral Ligament Reconstruction
The medial patellofemoral ligament (MPFL) has been recognized as an important soft tissue restraint in preventing lateral patellar translation. As many patients with acute or chronic patellar instability will have a deficient MPFL, reconstruction of this ligament is becoming more common. Appropriately, significant research has been undertaken regarding graft biomechanics and techniques, as intr...
متن کاملRadiographic Location Does Not Ensure a Precise Anatomic Location of the Femoral Fixation Site in Medial Patellofemoral Ligament Reconstruction
Background A frequently used method to determine the anatomic femoral fixation point in the operating room during medial patellofemoral ligament (MPFL) reconstruction is the radiographic method. However, the ability of this radiological method to establish an anatomic femoral attachment point might not be as accurate as expected. Purpose (1) To evaluate the accuracy of the radiological method...
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BACKGROUND Radiographic landmarks for medial knee attachment sites during anatomic repairs or reconstructions are unknown. If identified, they could assist in the preoperative evaluation of structure location and allow for postoperative assessment of reconstruction tunnel placement. METHODS Radiopaque markers were implanted into the femoral and tibial attachments of the superficial medial col...
متن کاملDynamic Simulation of the Effects of Graft Fixation Errors During Medial Patellofemoral Ligament Reconstruction
BACKGROUND Medial patellofemoral ligament (MPFL) reconstruction is performed to prevent recurrent instability, but errors in femoral fixation can elevate graft tension. HYPOTHESIS Errors related to femoral fixation will overconstrain the patella and increase medial patellofemoral pressures. STUDY DESIGN Controlled laboratory study. METHODS Five knees with patellar instability were represe...
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ورودعنوان ژورنال:
- Orthopaedic journal of sports medicine
دوره 3 1 شماره
صفحات -
تاریخ انتشار 2015