Format

Send to

Choose Destination
Arthroscopy. 2018 Feb;34(2):502-510. doi: 10.1016/j.arthro.2017.08.256.

Anisometry of Medial Patellofemoral Ligament Reconstruction in the Setting of Increased Tibial Tubercle-Trochlear Groove Distance and Patella Alta.

Author information

1
Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York. Electronic address: lauren.redler@columbia.edu.
2
Department of Biomechanics, Hospital for Special Surgery, New York, New York.
3
Department of Orthopedic Surgery, Oregon Health & Science University, Portland, Oregon.
4
Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York.
5
Department of Biostatistics, Hospital for Special Surgery, New York, New York.
6
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York; Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York.

Abstract

PURPOSE:

To assess the impact elevated tibial tubercle-trochlear groove (TT-TG) distance and patella height, as measured by the Caton-Deschamps Index (CDI), have on the isometry of a reconstructed medial patellofemoral ligament (MPFL).

METHODS:

Nine fresh-frozen cadaveric knees were placed on a custom testing fixture, with a fixed femur and a mobile tibia. A suture fixed to the MPFL origin on the patella and free to move at the Schöttle point on the femur represented a reconstructed MPFL. A local coordinate system was established, and retroreflective markers attached to the suture quantified MPFL length changes by use of a 3-dimensional motion capture system. The tubercle was transferred to create TT-TG distances of 20 mm and 25 mm and CDIs of 1.2 and 1.4 (patella alta). Recordings of the MPFL suture length change as the knee was brought through a range of motion were made using all combinations of tubercle anatomy in a randomized order for each specimen. A generalized estimating equation modeling technique was used to analyze and control for the clustered nature of the data.

RESULTS:

Knees with native tibial tubercle anatomy showed MPFL isometry through 20° to 70° range of motion. Tibial tubercle lateralization (increased TT-TG distance) significantly altered MPFL isometry with a TT-TG distance of 20 mm (P < .0001). Patella alta significantly altered MPFL isometry with a CDI of 1.2 (P = .0182). The interaction of tibial tubercle lateralization combined with patella alta significantly increased the amount of anisometry seen in the reconstructed MPFL (P < .001).

CONCLUSIONS:

Increased tibial tubercle lateralization and patella alta produce anisometry in an MPFL reconstruction using currently recommended landmarks, leading to potentially increased graft tension and potential failure.

CLINICAL RELEVANCE:

Tibial tubercle transfer should be considered when performing an MPFL reconstruction for recurrent patellofemoral instability in the setting of significant patella alta and an elevated TT-TG distance-especially when both are present-because an isolated MPFL reconstruction will be prone to failure given the anisometry shown in this study.

PMID:
29100777
DOI:
10.1016/j.arthro.2017.08.256
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center