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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-10-2017 | Knee

Impact of the patella height on the strain pattern of the medial patellofemoral ligament after reconstruction: a computer model-based study

Authors: Thomas Tischer, Andreas Geier, Robert Lenz, Christoph Woernle, Rainer Bader

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2017

Abstract

Purpose

Medial patellofemoral ligament (MPFL) reconstruction is a key procedure for treating patellofemoral instability. However, controversy exists regarding the correct graft placement in different patellar heights. Therefore, our study aimed to investigate the influence of patellar height on MPFL insertion points.

Methods

Strain patterns of the reconstructed MPFL were calculated using a dynamic musculoskeletal multibody simulation. Numerous patellar (proximal, central, distal) and femoral attachment sites (around the radiological point according to Schöttle) were analysed in the presence of different patella heights [Insall–Salvati (IS) indices 0.74, 1.0, 1.5] during dynamic knee flexion from 0° to 120°.

Results

The reconstructed MPFL showed an almost isometric behaviour at the anatomic insertion (IS 1.0). Slight variation (<5 mm) around the ideal femoral insertion point resulted in only small changes in MPFL tension. However, a displacement of 10 mm led to a significant increase in MPFL tension, especially in the more anteriorly/proximally located femoral attachment points. Depending on the patella height, there exists an area of absolute isometry of the MPFL (length change <3 %) on the femoral condyle, which did not necessarily coincide exactly with the radiological point, but was located within a radius of 5 mm around it.

Conclusions

When reconstructed in the radiological femoral insertion point, MPFL strain patterns were only slightly affected by different patella heights (IS 0.74–1.5) suggesting that MPFL reconstruction could be safely performed using the radiological insertion. However, in case of a patella alta (IS 1.5), a slightly more proximal femoral insertion is beneficial for the biomechanical behaviour of the reconstructed MPFL.

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Title: Impact of the patella height on the strain pattern of the medial patellofemoral ligament after reconstruction: a computer model-based study
Authors: Thomas Tischer
Andreas Geier
Robert Lenz
Christoph Woernle
Rainer Bader
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-016-4190-2

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Springer Medicine

Impact of the patella height on the strain pattern of the medial patellofemoral ligament after reconstruction: a computer model-based study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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