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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-09-2017 | Knee

Fluoroscopic control allows for precise tunnel positioning in MPFL reconstruction

Authors: Vera Jaecker, Benedikt Brozat, Marc Banerjee, Robin Otchwemah, Bertil Bouillon, Sven Shafizadeh

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2017

Abstract

Purpose

In MPFL reconstruction, anatomical graft positioning is required to restore physiological joint biomechanics and patellofemoral stability. Considerable rates of non-anatomical femoral tunnel placement exist. The purpose of this study was to analyse whether intraoperative fluoroscopic control is applicable to reduce variability of femoral tunnel positioning.

Methods

Femoral tunnel positions of 116 consecutive MPFL reconstructions applying intraoperative fluoroscopic images were analysed. Tunnel positions were determined by two independent observers according to Schöttle’s radiographic measurement method. Mean positions, standard deviations and ranges were calculated to determine the variability of the tunnel positions. Interclass correlation coefficient (ICC) was calculated.

Results

The mean anterior/posterior distances from the anatomical insertion of the MPFL to the centre of the femoral tunnel were 2.34 mm (range 0.0–5.9 mm) and 1.7 mm (range 0.1–7.3 mm, SD 1.3) for proximal/distal deviations; 95.7 % (111/116) of femoral tunnel positions were found to be within the anatomical insertion area defined by Schöttle. Interobserver tunnel position measurements were highly reliable (ICC: depth 0.979; height 0.979).

Conclusion

The study demonstrates that intraoperative fluoroscopic control is a feasible and effective method that enables to create reproducible and precise anatomical femoral tunnel positions in MPFL reconstruction. Accordingly, the routine use of intraoperative fluoroscopy can be recommended. Furthermore, the results indicate Schöttle’s method as a reliable method for intraoperative control and postoperative analysis of femoral tunnel positioning.

Level of evidence

IV.

Amis AA (2007) Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc 15(2):48–56CrossRefPubMed

Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220CrossRefPubMed

Araujo PH, Moloney G, Rincon G, Carey R, Zhang X, Harner C (2014) Use of a fluoroscopic overlay to guide femoral tunnel placement during posterior cruciate ligament reconstruction. Am J Sports Med 42(11):2673–2679CrossRefPubMed

Barnett AJ, Howells NR, Burston BJ, Ansari A, Clark D, Eldridge JD (2012) Radiographic landmarks for tunnel placement in reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 20(12):2380–2384CrossRefPubMed

Bicos J, Fulkerson JP, Amis A (2007) Current concepts review: the medial patellofemoral ligament. Am J Sports Med 35(3):484–492CrossRefPubMed

Buckens CF, Saris DB (2010) Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med 38(1):181–188CrossRefPubMed

Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 17(3):220–227CrossRefPubMed

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):1478–1485CrossRefPubMed

Farr J, Schepsis AA (2006) Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. J Knee Surg 19(4):307–316CrossRefPubMed

10.

Feller JA, Richmond AK, Wasiak J (2014) Medial patellofemoral ligament reconstruction as an isolated or combined procedure for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 22(10):2470–2476CrossRefPubMed

11.

Fisher B, Nyland J, Brand E, Curtin B (2010) Medial patellofemoral ligament reconstruction for recurrent patellar dislocation: a systematic review including rehabilitation and return-to-sports efficacy. Arthroscopy 26(10):1384–1394CrossRefPubMed

12.

Fujino K, Tajima G, Yan J, Kamei Y, Maruyama M, Takeda S, Kikuchi S, Shimamura T (2015) Morphology of the femoral insertion site of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 23(4):998–1003CrossRefPubMed

13.

Hopper GP, Leach WJ, Rooney BP, Walker CR, Blyth MJ (2014) Does degree of trochlear dysplasia and position of femoral tunnel influence outcome after medial patellofemoral ligament reconstruction? Am J Sports Med 42(3):716–722CrossRefPubMed

14.

Kita K, Horibe S, Toritsuka Y, Nakamura N, Tanaka Y, Yonetani Y, Mae T, Nakata K, Yoshikawa H, Shino K (2012) Effects of medial patellofemoral ligament reconstruction on patellar tracking. Knee Surg Sports Traumatol Arthrosc 20(5):829–837CrossRefPubMed

15.

Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33(2):363–374CrossRefPubMed

16.

LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89(9):2000–2010PubMed

17.

McCarthy M, Ridley TJ, Bollier M, Wolf B, Albright J, Amendola A (2013) Femoral tunnel placement in medial patellofemoral ligament reconstruction. Iowa Orthop J 33:58–63PubMedPubMedCentral

18.

Melegari TM, Parks BG, Matthews LS (2008) Patellofemoral contact area and pressure after medial patellofemoral ligament reconstruction. Am J Sports Med 36(4):747–752CrossRefPubMed

19.

Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23(5):260–263CrossRefPubMedPubMedCentral

20.

Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7(2):121–127CrossRefPubMed

21.

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):510–515CrossRefPubMed

22.

Parikh SN, Nathan ST, Wall EJ, Eismann EA (2013) Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med 41(5):1030–1038CrossRefPubMed

23.

Placella G, Tei M, Sebastiani E, Speziali A, Antinolfi P, Delcogliano M, Georgoulis A, Cerulli G (2014) Anatomy of the medial patello-femoral ligament: a systematic review of the last 20 years literature. Musculoskelet Surg. doi:10.1007/s12306-014-0335-y

24.

Redfern J, Kamath G, Burks R (2010) Anatomical confirmation of the use of radiographic landmarks in medial patellofemoral ligament reconstruction. Am J Sports Med 38(2):293–297CrossRefPubMed

25.

Schöttle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35(5):801–804CrossRefPubMed

26.

Servien E, Fritsch B, Lustig S, Demey G, Debarge R, Lapra C, Neyret P (2011) In vivo positioning analysis of medial patellofemoral ligament reconstruction. Am J Sports Med 39(1):134–139CrossRefPubMed

27.

Shafizadeh S, Balke M (2014) Medial patellofemoral ligament reconstruction: a new technique for graft fixation at the patella without implants. Arthrosc Tech 3(1):e115–e117CrossRefPubMedPubMedCentral

28.

Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40(8):1916–1923CrossRefPubMedPubMedCentral

29.

Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10(3):221–227CrossRefPubMed

30.

Steensen RN, Dopirak RM, McDonald WG 3rd (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32(6):1509–1513CrossRefPubMed

31.

Stephen JM, Kaider D, Lumpaopong P, Deehan DJ, Amis AA (2014) The effect of femoral tunnel position and graft tension on patellar contact mechanics and kinematics after medial patellofemoral ligament reconstruction. Am J Sports Med 42(2):364–372CrossRefPubMed

32.

Stephen JM, Lumpaopong P, Deehan DJ, Kader D, Amis AA (2012) The medial patellofemoral ligament: location of femoral attachment and length change patterns resulting from anatomic and nonanatomic attachments. Am J Sports Med 40(8):1871–1879CrossRefPubMed

33.

Sven S, Maurice B, Hoeher J, Marc B (2014) Variability of tunnel positioning in fluoroscopic-assisted ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3029-y PubMed

34.

Thaunat M, Erasmus PJ (2007) The favourable anisometry: an original concept for medial patellofemoral ligament reconstruction. Knee 14(6):424–428CrossRefPubMed

35.

Torabi M, Wo S, Vyas D, Costello J (2015) MRI evaluation and complications of medial patellofemoral ligament reconstruction. Clin Imaging 39(1):116–127CrossRefPubMed

36.

Tuxoe JI, Teir M, Winge S, Nielsen PL (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10(3):138–140CrossRefPubMed

37.

Viste A, Chatelet F, Desmarchelier R, Fessy MH (2014) Anatomical study of the medial patello-femoral ligament: landmarks for its surgical reconstruction. Surg Radiol Anat 36(8):733–739CrossRefPubMed

Title: Fluoroscopic control allows for precise tunnel positioning in MPFL reconstruction
Authors: Vera Jaecker
Benedikt Brozat
Marc Banerjee
Robin Otchwemah
Bertil Bouillon
Sven Shafizadeh
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-015-3613-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Fluoroscopic control allows for precise tunnel positioning in MPFL reconstruction

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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