Isolated Medial Patellofemoral Ligament Reconstruction Under Increased Femoral Anteversion Is Associated With Increased Contact Pressure of Medial Patellofemoral Facet at Deep Flexion Angle: A Cadaveric Study
To analyze (1) whether isolated medial patellofemoral ligament (MPFL) reconstruction in increased femoral anteversion could replicate the patellofemoral (PF) pressure pattern of a hypothetical normal population and (2) the change of PF pressure according to MPFL state under the same anteversion sett...
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| Published in | Arthroscopy |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
27.03.2025
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| Online Access | Get full text |
| ISSN | 0749-8063 1526-3231 1526-3231 |
| DOI | 10.1016/j.arthro.2025.03.040 |
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| Abstract | To analyze (1) whether isolated medial patellofemoral ligament (MPFL) reconstruction in increased femoral anteversion could replicate the patellofemoral (PF) pressure pattern of a hypothetical normal population and (2) the change of PF pressure according to MPFL state under the same anteversion setting.
Ten fresh-frozen cadaveric knees were used. Experiments were performed from knee flexion 0° to 90° with 3 MPFL state (intact, released, and reconstructed) and 3 anteversion (initial state, 10° and 20° more increased). Medial and lateral PF joint contact pressures were measured at each point.
At 0° flexion, lateral PF pressure was increased to 62.1 ± 7.8 psi in 10° and 67.3 ± 13.5 psi in 20° more increased anteversion, compared with 43.2 ± 8.6 psi of hypothetical normal population (P .027 and .004, respectively). At 30° flexion, medial PF pressure was decreased to 31.3 ± 11.9 psi in 10° and 27.3 ± 17.5 psi in 20° more increased anteversion, compared with 44.1 ± 10.3 psi of hypothetical normal population (P .009 and .027, respectively). Within the same femoral anteversion, when anteversion was increased 10° and 20° more than the initial state, medial facet pressure after MPFL reconstruction at 90° flexion was increased from 28.7 ± 11.4 psi to 40.0 ± 9.9 psi and 16.7 ± 10.8 psi to 33.9 ± 15.0 psi compared with the intact MPFL (P .047 and <.001, respectively).
Biomechanically, isolated MPFL reconstruction under increased femoral anteversion was unable to replicate the state of a hypothetical normal population. Even when comparing within the same femoral anteversion, isolated MPFL reconstruction at increased femoral anteversion caused medial PF overpressure at 90° flexion angle.
When performing MPFL reconstruction for recurrent patellar dislocation, femoral anteversion should be assessed. Increased femoral anteversion can cause overpressure on the medial facet after isolated MPFL reconstruction. |
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| AbstractList | To analyze (1) whether isolated medial patellofemoral ligament (MPFL) reconstruction in increased femoral anteversion could replicate the patellofemoral (PF) pressure pattern of a hypothetical normal population and (2) the change of PF pressure according to MPFL state under the same anteversion setting.
Ten fresh-frozen cadaveric knees were used. Experiments were performed from knee flexion 0° to 90° with 3 MPFL state (intact, released, and reconstructed) and 3 anteversion (initial state, 10° and 20° more increased). Medial and lateral PF joint contact pressures were measured at each point.
At 0° flexion, lateral PF pressure was increased to 62.1 ± 7.8 psi in 10° and 67.3 ± 13.5 psi in 20° more increased anteversion, compared with 43.2 ± 8.6 psi of hypothetical normal population (P .027 and .004, respectively). At 30° flexion, medial PF pressure was decreased to 31.3 ± 11.9 psi in 10° and 27.3 ± 17.5 psi in 20° more increased anteversion, compared with 44.1 ± 10.3 psi of hypothetical normal population (P .009 and .027, respectively). Within the same femoral anteversion, when anteversion was increased 10° and 20° more than the initial state, medial facet pressure after MPFL reconstruction at 90° flexion was increased from 28.7 ± 11.4 psi to 40.0 ± 9.9 psi and 16.7 ± 10.8 psi to 33.9 ± 15.0 psi compared with the intact MPFL (P .047 and <.001, respectively).
Biomechanically, isolated MPFL reconstruction under increased femoral anteversion was unable to replicate the state of a hypothetical normal population. Even when comparing within the same femoral anteversion, isolated MPFL reconstruction at increased femoral anteversion caused medial PF overpressure at 90° flexion angle.
When performing MPFL reconstruction for recurrent patellar dislocation, femoral anteversion should be assessed. Increased femoral anteversion can cause overpressure on the medial facet after isolated MPFL reconstruction. This study aimed to analyze (1) whether isolated medial patellofemoral ligament (MPFL) reconstruction in increased femoral anteversion could replicate patellofemoral (PF) pressure pattern of a hypothetical normal population, and (2) the change of PF pressure according to MPFL state under the same anteversion setting.PURPOSEThis study aimed to analyze (1) whether isolated medial patellofemoral ligament (MPFL) reconstruction in increased femoral anteversion could replicate patellofemoral (PF) pressure pattern of a hypothetical normal population, and (2) the change of PF pressure according to MPFL state under the same anteversion setting.Ten fresh-frozen cadaveric knees were used. Experiments were performed from knee flexion 0° to 90° with three MPFL state (intact, released, and reconstructed) and three anteversion (initial state, 10° and 20° more increased). Medial and lateral PF joint contact pressures were measured at each point.METHODSTen fresh-frozen cadaveric knees were used. Experiments were performed from knee flexion 0° to 90° with three MPFL state (intact, released, and reconstructed) and three anteversion (initial state, 10° and 20° more increased). Medial and lateral PF joint contact pressures were measured at each point.At 0° flexion, lateral PF pressure was increased to 62.1 ± 7.8 psi in 10° and 67.3 ± 13.5 psi in 20° more increased anteversion, compared to 43.2 ± 8.6 psi of hypothetical normal population (P-value 0.027 and 0.004, respectively). At 30° flexion, medial PF pressure was decreased to 31.3 ± 11.9 psi in 10° and 27.3 ± 17.5 psi in 20° more increased anteversion, compared to 44.1 ± 10.3 psi of hypothetical normal population (P-value 0.009 and 0.027, respectively). Within the same femoral anteversion, when anteversion was increased 10° and 20° more than the initial state, medial facet pressure after MPFL reconstruction at 90° flexion was increased from 28.7 ± 11.4 to 40.0 ± 9.9 psi and 16.7 ± 10.8 to 33.9 ± 15.0 psi compared to the intact MPFL (P-value 0.047 and <0.001, respectively).RESULTSAt 0° flexion, lateral PF pressure was increased to 62.1 ± 7.8 psi in 10° and 67.3 ± 13.5 psi in 20° more increased anteversion, compared to 43.2 ± 8.6 psi of hypothetical normal population (P-value 0.027 and 0.004, respectively). At 30° flexion, medial PF pressure was decreased to 31.3 ± 11.9 psi in 10° and 27.3 ± 17.5 psi in 20° more increased anteversion, compared to 44.1 ± 10.3 psi of hypothetical normal population (P-value 0.009 and 0.027, respectively). Within the same femoral anteversion, when anteversion was increased 10° and 20° more than the initial state, medial facet pressure after MPFL reconstruction at 90° flexion was increased from 28.7 ± 11.4 to 40.0 ± 9.9 psi and 16.7 ± 10.8 to 33.9 ± 15.0 psi compared to the intact MPFL (P-value 0.047 and <0.001, respectively).Biomechanically, isolated MPFL reconstruction under increased femoral anteversion was unable to replicate the state of a hypothetical normal population. Even when comparing within the same femoral anteversion, isolated MPFL reconstruction at increased femoral anteversion caused medial PF overpressure at 90° flexion angle.CONCLUSIONSBiomechanically, isolated MPFL reconstruction under increased femoral anteversion was unable to replicate the state of a hypothetical normal population. Even when comparing within the same femoral anteversion, isolated MPFL reconstruction at increased femoral anteversion caused medial PF overpressure at 90° flexion angle.When performing MPFL reconstruction for recurrent patellar dislocation, femoral anteversion should be assessed. Increased femoral anteversion can cause overpressure on the medial facet following isolated MPFL reconstruction.CLINICAL RELEVANCEWhen performing MPFL reconstruction for recurrent patellar dislocation, femoral anteversion should be assessed. Increased femoral anteversion can cause overpressure on the medial facet following isolated MPFL reconstruction. |
| Author | Park, Jisu D’Lima, Darryl D. Kwak, Dai-Soon Chang, Moon Jong Piao, Zhanguang Shin, Seonjin Kim, Tae Woo |
| Author_xml | – sequence: 1 givenname: Jisu orcidid: 0000-0002-6794-3623 surname: Park fullname: Park, Jisu organization: Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea – sequence: 2 givenname: Zhanguang surname: Piao fullname: Piao, Zhanguang organization: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea – sequence: 3 givenname: Seonjin surname: Shin fullname: Shin, Seonjin organization: Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea – sequence: 4 givenname: Tae Woo surname: Kim fullname: Kim, Tae Woo organization: Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea – sequence: 5 givenname: Moon Jong surname: Chang fullname: Chang, Moon Jong organization: Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea – sequence: 6 givenname: Darryl D. orcidid: 0000-0002-8707-1455 surname: D’Lima fullname: D’Lima, Darryl D. organization: Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, U.S.A – sequence: 7 givenname: Dai-Soon orcidid: 0000-0002-5129-688X surname: Kwak fullname: Kwak, Dai-Soon email: daisoon@catholic.ac.kr organization: Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea |
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| Snippet | To analyze (1) whether isolated medial patellofemoral ligament (MPFL) reconstruction in increased femoral anteversion could replicate the patellofemoral (PF)... This study aimed to analyze (1) whether isolated medial patellofemoral ligament (MPFL) reconstruction in increased femoral anteversion could replicate... |
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| Title | Isolated Medial Patellofemoral Ligament Reconstruction Under Increased Femoral Anteversion Is Associated With Increased Contact Pressure of Medial Patellofemoral Facet at Deep Flexion Angle: A Cadaveric Study |
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