Medial Patellofemoral Ligament Reconstruction Reduces Radiographic Measures of Patella Alta in Adults

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Abstract

Background:

Patellar height has long been considered a risk factor for patellofemoral instability. However, recent pediatric literature demonstrated a reduction in patellar height measurements following medial patellofemoral ligament (MPFL) reconstruction.

Purpose:

To assess the mean change in patellar height and the percentage of skeletally mature patients with patellar height ratios reduced to within-normal limits following MPFL reconstruction.

Study Design:

Case series; Level of evidence, 4.

Methods:

Adult patients undergoing primary MPFL reconstruction for recurrent lateral patellar instability between 2005 and 2013 were identified. Pre- and postoperative (within 1 year of surgery) lateral knee radiographs were assessed for patellar height indices, including Caton-Deschamps, Blackburne-Peel, and Insall-Salvati ratios. The change in patellar height and the number of patients reduced from abnormal to normal patellar height ratios following MPFL reconstruction were assessed.

Results:

Overall, 32 adult patients were included in the study, with a mean age of 25.7 years (range, 18-55 years). There were 21 women (66%) and 11 men (34%). Insall-Salvati, Blackburne-Peel, and Caton-Deschamps ratios all demonstrated significant reductions in patellar height between pre- and postoperative lateral knee radiographs ( P < .001). All 3 indices showed a reduction in the number of patients meeting the criteria for patella alta following MPFL reconstruction. A total of 64% of patients had an abnormal preoperative Caton-Deschamps ratio reduced to within normal limits postoperatively.

Conclusion:

MPFL reconstruction provides a consistent reduction in patellar height measurements. The Caton-Deschamps ratio was reduced to the reference range following MPFL reconstruction in 64% of patients with preoperative patella alta. Surgeons treating patellofemoral instability should expect a reduction in patellar height after ligament reconstruction, which may affect the need for more invasive distalization procedures.

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Most cited references 16

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Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction.

Philip Schöttle, Arno Schmeling, Nikolaus Rosenstiel … (2007)

Reconstruction of the medial patellofemoral ligament has recently become popular for restoring patellofemoral stability. Femoral insertion site anatomy of the medial patellofemoral ligament has been described. This anatomical insertion has been inferred to be the isometric point in medial patellofemoral ligament reconstruction, but data about radiographic landmarks for a postoperative or intraoperative control are missing. To determine the radiographic landmarks for control of postoperative and intraoperative femoral medial patellofemoral ligament insertion. Descriptive laboratory study. Eight fresh-frozen human knees were dissected, and the medial patellofemoral ligament was exposed. After identification of the femoral medial patellofemoral ligament insertion site, the insertion center was marked with a lead ball of 2-mm diameter. Straight lateral radiographs were taken, and posterior-anterior as well as proximal-distal position were evaluated. Six of 8 insertion points were anterior to a line representing an extension of the posterior cortex, 1 point was touching this line, and 1 point was posterior to it. All points were situated distal to the posterior origin of the medial femoral condyle and proximal to the most posterior point of the Blumensaat line. A reproducible anatomical and radiographic point, 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of the Blumensaat line on a lateral radiograph with both posterior condyles projected in the same plane, shows the mean femoral medial patellofemoral ligament center. This radiographic point may be useful both intraoperatively and postoperatively.

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Factors of patellar instability: an anatomic radiographic study.

H DEJOUR, L Nové-Josserand, C Guier … (1993)

We analyzed the radiographs and computed tomography (CT) scans of 143 knees operated on for symptomatic patellar instability and 67 contralateral asymptomatic knees, together with 190 control knee radiographs and 27 control knee scans, to determine the factors affecting patellar instability. Four factors were relevant in knees with symptomatic patellar instability: (1) Trochlear dysplasia (85%), as defined by the crossing sign (96%) and quantitatively expressed by the trochlear bump, pathological above 3 mm or more (66%), and the trochlear depth, pathologic at 4 mm or less. (2) Quadriceps dysplasia (83%), defined a present when the patellar tilt in extension is more than 20% on the CT scans. (3) Patella alta (Caton-Deschamps) index greater than or equal to 1.2 (24%). (4) Tibial tuberosity-trochlear groove, pathological when greater than or equal to 20 mm (56%). The factors appeared in only 3%-6.5% of the control knees. The etiology of patellar instability is multifactorial. Determination of the factors permits an effective elective therapeutic plan which aims at correcting the anomalies present.

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The anatomy of the medial part of the knee.

Robert F LaPrade, Anders Hauge Engebretsen, Thuan V Ly … (2007)

While the anatomy of the medial part of the knee has been described qualitatively, quantitative descriptions of the attachment sites of the main medial knee structures have not been reported. The purpose of the present study was to verify the qualitative anatomy of medial knee structures and to perform a quantitative evaluation of their anatomic attachment sites as well as their relationships to pertinent osseous landmarks. Dissections were performed and measurements were made for eight nonpaired fresh-frozen cadaveric knees with use of an electromagnetic three-dimensional tracking sensor system. In addition to the medial epicondyle and the adductor tubercle, a third osseous prominence, the gastrocnemius tubercle, which corresponded to the attachment site of the medial gastrocnemius tendon, was identified. The average length of the superficial medial (tibial) collateral ligament was 94.8 mm. The superficial medial collateral ligament femoral attachment was 3.2 mm proximal and 4.8 mm posterior to the medial epicondyle. The superficial medial collateral ligament had two separate attachments on the tibia. The distal attachment of the superficial medial collateral ligament on the tibia was 61.2 mm distal to the knee joint. The deep medial collateral ligament consisted of meniscofemoral and meniscotibial portions. The posterior oblique ligament femoral attachment was 7.7 mm distal and 6.4 mm posterior to the adductor tubercle and 1.4 mm distal and 2.9 mm anterior to the gastrocnemius tubercle. The medial patellofemoral ligament attachment on the femur was 1.9 mm anterior and 3.8 mm distal to the adductor tubercle. The medial knee ligament structures have a consistent attachment pattern.

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Author and article information

Journal

Journal ID (nlm-ta): Orthop J Sports Med

Journal ID (iso-abbrev): Orthop J Sports Med

Journal ID (publisher-id): OJS

Journal ID (hwp): spojs

Title: Orthopaedic Journal of Sports Medicine

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Electronic): 2325-9671

Publication date (Electronic): 25 January 2018

Publication date Collection: January 2018

Volume: 6

Issue: 1

Electronic Location Identifier: 2325967117751659

Affiliations

[† ]Departments of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.

[2-2325967117751659] Investigation performed at the Mayo Clinic, Rochester, Minnesota, USA

Author notes

[*] [* ]Jarret M. Woodmass, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA (email: woodmass.jarret@ 123456mayo.edu ).

Article

Publisher ID: 10.1177_2325967117751659

DOI: 10.1177/2325967117751659

PMC ID: 5788106

PubMed ID: 29399590

SO-VID: f519d24f-567c-4488-84c9-f3d671640597

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Keywords: patellar instability,mpfl reconstruction,patellar height,patellofemoral arthritis

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Keywords: patellar instability, mpfl reconstruction, patellar height, patellofemoral arthritis

Medial Patellofemoral Ligament Reconstruction Reduces Radiographic Measures of Patella Alta in Adults

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Abstract

Background:

Purpose:

Study Design:

Methods:

Results:

Conclusion:

Related collections

Orthopedics

Most cited references 16

Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction.

Factors of patellar instability: an anatomic radiographic study.

The anatomy of the medial part of the knee.

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