Patellar fixation graft via suture anchors versus tunnel techniques during isolated MPFL reconstruction for recurrent patellofemoral instability: a systematic review of the literature.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare that they have no conflicts of interest. 20. J Biomech Eng. 2023 Apr 1;145(4):041003. doi: 10.1115/1.4055886. Anatomical Characteristics Contributing to Patellar Dislocations Following MPFL Reconstruction: A Dynamic Simulation Study. Watts JC(1), Farrow LD(2), Elias JJ(3). Author information: (1)Department of Orthopedic Surgery, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307. (2)Orthopaedic & Rheumatologic Institute, Cleveland Clinic Sports Health Center, 5555 Transportation Boulevard, Garfield Heights, OH 44125. (3)Department of Health Sciences, Cleveland Clinic Akron General, 1 Akron General Avenue Akron, OH 44307. Pathologic anatomy is a primary factor contributing to redislocation of the patella following reconstruction of the medial patellofemoral ligament (MPFL). A pivot landing was simulated following MPFL reconstruction, with the hypothesis that position of the tibial tuberosity, depth of the trochlear groove, and height of the patella are correlated with lateral patellar maltracking. Thirteen dynamic simulation models represented subjects being treated for recurrent patellar instability. Simplified Hertzian contact governed patellofemoral and tibiofemoral joint reaction forces. Pivot landing was represented with and without an MPFL graft in place. Measurements related to patellar height (Caton-Deschamps index), trochlear groove depth (lateral trochlear inclination), and position of the tibial tuberosity (lateral tibial tuberosity to posterior cruciate attachment distance, or lateral TT-PCL distance) were measured from the models and correlated with patellar lateral shift with the knee extended (5 deg of flexion) and flexed (40 deg). The patella dislocated for all models without an MPFL graft and for two models with a graft represented. With an MPFL graft represented, patellar lateral shift was correlated with Caton-Deschamps index (r2 > 0.35, p