Return to Play Considerations After Patellar Instability.

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Abstract

Conflict of interest statement: The authors did not receive any funding or grants in support of the research for or preparation of this work. The authors declare no conflict of interest. 18. BMC Musculoskelet Disord. 2022 Feb 11;23(1):139. doi: 10.1186/s12891-022-05013-5. Lateral release associated with MPFL reconstruction in patients with acute patellar dislocation. Kheir N(#)(1), Salvatore G(#)(2), Berton A(#)(2), Orsi A(3), Egan J(1), Mohamadi A(1), DeAngelis JP(4), Ramappa AJ(4), Longo UG(#)(2), Denaro V(#)(2), Nazarian A(#)(5)(6). Author information: (1)Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. (2)Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy. (3)Clinical Research, Corin, Raynham, MA, USA. (4)Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. (5)Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. anazaria@bidmc.harvard.edu. (6)Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia. anazaria@bidmc.harvard.edu. (#)Contributed equally OBJECTIVE: Medial patellofemoral ligament (MPFL) injury occurs in the majority of the cases of acute patellar dislocation. The role of concomitant lateral retinaculum release with MPFL reconstruction is not clearly understood. Even though the lateral retinaculum plays a role in both medial and lateral patellofemoral joint stability in MPFL intact knees, studies have shown mixed clinical outcomes following its release during MPFL reconstruction surgery. Better understanding of the biomechanical effects of the release of the lateral retinaculum during MPFL reconstruction is warranted. We hypothesize that performing a lateral release concurrent with MPFL reconstruction will disrupt the patellofemoral joint biomechanics and result in lateral patellar instability. METHODS: A previously developed and validated finite element (FE) model of the patellofemoral joint was used to understand the effect of lateral retinaculum release following MPFL reconstruction. Contact pressure (CP), contact area (CA) and lateral patellar displacement were recorded. abstract. RESULTS: FE modeling and analysis demonstrated that lateral retinacular release following MPFL reconstruction with tibial tuberosity-tibial groove distance (TT-TG) of 12 mm resulted in a 39% decrease in CP, 44% decrease in CA and a 20% increase in lateral patellar displacement when compared to a knee with an intact MPFL. In addition, there was a 45% decrease in CP, 44% decrease in CA and a 21% increase in lateral displacement when compared to a knee that only had an MPFL reconstruction. CONCLUSION: This FE-based analysis exhibits that concomitant lateral retinaculum release with MPFL reconstruction results in decreased PF CA, CP and increased lateral patellar displacement with increased knee flexion, which may increase the risk of patellar instability. © 2022. The Author(s). DOI: 10.1186/s12891-022-05013-5 PMCID: PMC8832651