Allowing one quadrant of patellar lateral translation during medial patellofemoral ligament reconstruction successfully limits maltracking without overconstraining the patella
| Autor: | Molly K. Lalonde, S. Cyrus Rezvanifar, Andrew J. Cosgarea, Kerwyn C. Jones, Joseph N. Gabra, John J. Elias |
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| Rok vydání: | 2017 |
| Předmět: |
Joint Instability
Male musculoskeletal diseases medicine.medical_specialty Patellar cartilage Adolescent Transplants Medial patellofemoral ligament Models Biological Article Computational simulation Patellofemoral Joint Young Adult 03 medical and health sciences Quadrant (abdomen) 0302 clinical medicine Pressure medicine Humans Computer Simulation Orthopedics and Sports Medicine Recurrent instability Range of Motion Articular Child Orthodontics 030222 orthopedics business.industry Patella 030229 sport sciences Anatomy Plastic Surgery Procedures musculoskeletal system Biomechanical Phenomena medicine.anatomical_structure Ligaments Articular Orthopedic surgery Squatting position Female Surgery business human activities Contact pressure |
| Zdroj: | Knee Surgery, Sports Traumatology, Arthroscopy. 26:2883-2890 |
| ISSN: | 1433-7347 0942-2056 |
| DOI: | 10.1007/s00167-017-4799-9 |
| Popis: | PURPOSE: Graft tensioning during medial patellofemoral ligament (MPFL) reconstruction typically allows for lateral patellar translation within the trochlear groove. Computational simulation was performed to relate the allowed patellar translation to patellofemoral kinematics and contact pressures. METHODS: Multibody dynamic simulation models were developed to represent nine knees with patellar instability. Dual limb squatting was simulated representing the pre-operative condition and simulated MPFL reconstruction. The graft was tensioned to allow 10 mm, 5 mm and 0 mm of patellar lateral translation at 30° of knee flexion. The patellofemoral contact pressure distribution was quantified using discrete element analysis. RESULTS: For the 5 and 10 mm conditions, patellar lateral shift decreased significantly at 0° and 20°. The 0 mm condition significantly decreased lateral shift for nearly all flexion angles. All graft conditions significantly decreased lateral tilt at 0°, with additional significant decreases for the 5 and 0 mm conditions. The 0 mm condition significantly increased the maximum medial pressure at multiple flexion angles, increasing by 57% at 30°, but did not alter the maximum lateral pressure. CONCLUSIONS: Allowing 5 to 10 mm of patellar lateral translation limits lateral maltracking, thereby decreasing the risk of post-operative recurrent instability. Allowing no patellar translation during graft tensioning reduces maltracking further, but can overconstrain the patella, increasing the pressure applied to medial patellar cartilage already fibrillated or eroded from an instability episode. |
| Databáze: | OpenAIRE |
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