Analysis of Graft Length Change Patterns in Medial Patellofemoral Ligament Reconstruction via a Fluoroscopic Guidance Method
| Autor: | Kyohei Nishida, Kazuyuki Ibaraki, Shinya Oka, Tomoyuki Matsumoto, Masahiro Kurosaka, Daisuke Araki, Nobuaki Miyaji, Yuichi Hoshino, Toshikazu Tanaka, Noriyuki Kanzaki, Ryosuke Kuroda, Takehiko Matsushita |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Recurrent patellar dislocation Joint Dislocations Physical Therapy Sports Therapy and Rehabilitation Medial patellofemoral ligament True lateral Femoral attachment Arthroscopy Patellofemoral Joint Young Adult 03 medical and health sciences 0302 clinical medicine Suture Anchors medicine Humans Orthopedics and Sports Medicine Range of Motion Articular Suture anchors Orthodontics 030222 orthopedics Femoral tunnel business.industry Patella 030229 sport sciences Cross-Sectional Studies medicine.anatomical_structure Surgery Computer-Assisted Fluoroscopy Ligaments Articular Length change Female business |
| Zdroj: | The American Journal of Sports Medicine. 46:1150-1157 |
| ISSN: | 1552-3365 0363-5465 |
| DOI: | 10.1177/0363546517752667 |
| Popis: | Background: A fluoroscopic guidance method for medial patellofemoral ligament (MPFL) reconstruction has been widely used to determine the anatomic femoral attachment site. Purpose: To examine the graft length change patterns in MPFL reconstruction with a fluoroscopic guidance method. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Forty-four knees of 42 patients who underwent MPFL reconstruction for the treatment of recurrent patellar dislocation were examined prospectively. During surgery, suture anchors were inserted into the proximal one-third and center of the patella. A guide pin for the femoral tunnel was inserted into the position reported by Schöttle et al based on the true lateral view of the knee under fluoroscopic control. Changes in graft length patterns of the proximal and center anchors were examined through 0° to 120° of knee flexion. Favorable changes in length patterns were defined as meeting 2 of 3 criteria: (1) not long during flexion (≤3 mm between 30° and 120° of flexion) and either (2) nearly isometric during flexion between 0° and 90° or (3) slightly long during maximum extension (≤3 mm). Other patterns were considered unfavorable. If the change in length pattern was unfavorable, then the pin for the femoral tunnel was moved to different positions until it was favorable. Knees were separated into the favorable group and the unfavorable group. Differences between the groups regarding radiographic parameters were assessed. Student t test or chi-square test was used for statistical analysis. Results: Of the 44 knees, 31 (70.5%) showed favorable patterns. However, 13 knees (29.5%) showed unfavorable patterns; therefore, the position of the pin was changed. The mean ± SD distance from the original position to the final position was 5.3 ± 1.1 mm distal for 7 patients and 5.2 ± 0.4 mm posterodistal for 6 patients. Technical errors, including a nontrue lateral view and the tip of the wire not being in the determined area, were found for 4 of 13 knees in the unfavorable group. There was no statistical difference in radiographic parameters between the groups. Conclusion: The graft length change pattern could be nonphysiologic at the position determined through the fluoroscopic guidance method; thus, caution may be necessary. The change in length pattern should be checked before graft fixation. If the length change pattern is unfavorable, then it is advisable to move it approximately 5 to 7 mm distally or posterodistally from the first position. |
| Databáze: | OpenAIRE |
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