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Knee Surg Sports Traumatol Arthrosc. 2019 Aug 13. doi: 10.1007/s00167-019-05668-z. [Epub ahead of print]

Repair of the medial patellofemoral ligament with suture tape augmentation leads to similar primary contact pressures and joint kinematics like reconstruction with a tendon graft: a biomechanical comparison.

Author information

1
Department of Orthopaedic Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06030, USA.
2
Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
3
Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany.
4
Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany. imhoff@tum.de.
5
Orthopaedic Associates of Hartford, 499 Farmington Avenue, Farmington, CT, 06032, USA.

Abstract

PURPOSE:

To compare suture tape-augmented MPFL repair with allograft MPFL reconstruction using patellofemoral contact pressure and joint kinematics to assess the risk of patellofemoral over-constrainment at point zero.

METHODS:

A total of ten fresh frozen cadaveric knee specimens were tested in four different conditions of the MPFL: (1) native, (2) cut, (3) reconstructed with tendon graft, and (4) augmented with suture tape. The patellofemoral mean pressure (MP), peak pressure (PP) and contact area (CA) were measured independently for the medial and lateral compartments using pressure-sensitive films. Patellar tilt (PT) and shift (PS) were measured using an optical 3D motion tracking system. Measurements were recorded at 0°, 10°, 20°, 30°, 60° and 90° of flexion. Both the tendon graft and the internal brace were preloaded with 2 N, 5 N, and 10 N.

RESULTS:

There was no significant differences found between surgical methods for medial MP, medial PP, medial CA, lateral MP and PS at any preload or flexion angle. Significant differences were seen for lateral PP at 20° knee flexion and 10 N preload (suture tape vs. reconstruction: 1045.9 ± 168.7 kPa vs. 1003.0 ± 151.9 kPa; p = 0.016), for lateral CA at 10° knee flexion and 10 N preload (101.4 ± 39.5 mm2 vs. 108.7 ± 36.6 mm2; p = 0.040), for PT at 10° knee flexion and 2 N preload (- 1.9 ± 2.5° vs. - 2.5 ± 2.3°; p = 0.033) and for PT at 0° knee flexion and 10 N preload (- 0.8 ± 2.5° vs. - 1.8 ± 3.1°; p = 0.040). A preload of 2 N on the suture tape was the closest in restoring the native joint kinematics.

CONCLUSIONS:

Suture tape augmentation of the MPFL resulted in similar primary contact pressures and joint kinematics in comparison with MPFL reconstruction using a tendon graft. A pretension of 2 N was found to restore the knee joint closest to normal patellofemoral kinematics.

KEYWORDS:

Contact pressure; Internal ligament bracing; Joint kinematics; Ligament reconstruction; Medial patellofemoral ligament; Patellofemoral instability

PMID:
31410528
DOI:
10.1007/s00167-019-05668-z

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