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Reconstruction of the medial patellofemoral ligament with nonresorbable suture tape normalizes patellar maltracking independent of patella-side fixation technique

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patellar maltracking caused by a rupture of the medial patellofemoral ligament (MPFL) can be improved by MPFL reconstruction (MPFL-R) with a tendon graft. Nonresorbable suture tape (FiberTape®, FT) is possibly becoming an option to tendon grafts for MPFL-R. Patella-side fixation of FT can be performed with suture anchors or via soft-tissue fixation. The aim of this study was to investigate patellar tracking considering soft-tissue-based and anchor-based patella-side fixation techniques.

Methods

In eight fresh-frozen human knee joint specimens (m/f 4/4; age 75 ± 10 years), the MPFL was identified, and a rupture was placed near the femoral insertion site. In the study group (SG; 4 knees), soft-tissue fixation of the FT was performed at the medial patellar retinaculum; in the control group (CG; 4 knees), FT was fixed at the patella via suture anchors. For native MPFL (nMPFL), ruptured (“injured”) MPFL (iMPFL) and reconstructed MPFL (FT-MPFL-SG, respectively, FT-MPFL-CG) cone beam CT scans were performed in 15°, 30°, and 45° of knee joint flexion. Patellar tracking was assessed using the radiological parameters patellar tilt (PT), congruence angle (CA) and posterior patellar edge-trochlear groove ratio (PTR).

Results

All recorded radiological parameters increased, respectively, decreased in the CG and SG from the nMPFL to the iMPFL state. After MPFL-R, all parameters normalized when compared to the intact state (nMPFL), regardless of patella-side fixation technique. All investigated parameters of patellotrochlear alignment were positively, respectively, negatively significantly (p < 0.05) correlated throughout all evaluated conditions (nMPFL, iMPFL, FT-MPFL-SG, FT-MPFL-CG).

Conclusion

MPFL-R with a nonresorbable suture tape can normalize patellar maltracking in fresh-frozen human knee joint specimens in earlier degrees of knee joint flexion independent of patella-side fixation technique. The investigated parameters of patellotrochlear alignment correlate with each other.

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Data availability statement

The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Amis AA, Oguz C, Bull AMJ et al (2008) The effect of trochleoplasty on patellar stability and kinematics: a biomechanical study in vitro. J Bone Jt Surg Br 90:864–869. https://doi.org/10.1302/0301-620X.90B7.20447

    Article  CAS  Google Scholar 

  2. Arendt EA, Askenberger M, Agel J et al (2018) Risk of redislocation after primary patellar dislocation: a clinical prediction model based on magnetic resonance imaging variables. Am J Sports Med 46:3385–3390. https://doi.org/10.1177/0363546518803936

    Article  PubMed  Google Scholar 

  3. Balcarek P, Zimmermann F (2019) Deepening trochleoplasty and medial patellofemoral ligament reconstruction normalize patellotrochlear congruence in severe trochlear dysplasia. Bone Jt J 101-B:325–330. https://doi.org/10.1302/0301-620X.101B3.BJJ-2018-0795.R2

    Article  CAS  Google Scholar 

  4. Berruto M, Ferrua P, Uboldi F et al (2014) Medial patellofemoral ligament reconstruction with bioactive synthetic ligament is an option. A 3-year follow-up study. Knee Surg Sports Traumatol Arthrosc 22:2419–2425. https://doi.org/10.1007/s00167-014-2970-0

    Article  PubMed  Google Scholar 

  5. Dejour H, Walch G, Nove-Josserand L et al (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26. https://doi.org/10.1007/BF01552649

    Article  CAS  PubMed  Google Scholar 

  6. Dornacher D, Lippacher S, Nelitz M et al (2018) Impact of five different medial patellofemoral ligament-reconstruction strategies and three different graft pre-tensioning states on the mean patellofemoral contact pressure: a biomechanical study on human cadaver knees. J Exp Orthop 5:25. https://doi.org/10.1186/s40634-018-0140-x

    Article  PubMed  PubMed Central  Google Scholar 

  7. Frings J, Balcarek P, Tscholl P et al (2020) Conservative versus surgical treatment for primary patellar dislocation. Dtsch Arztebl Int 117:279–286. https://doi.org/10.3238/arztebl.2020.0279

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fu Z, Zhu Z, Chen H et al (2020) Surgical treatment is better than non-surgical treatment for primary patellar dislocation: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 140:219–229. https://doi.org/10.1007/s00402-019-03308-2

    Article  PubMed  Google Scholar 

  9. Golden T, Friedman AMB, Jazayeri R et al (2019) Primary repair of the medial collateral ligament with a double row suture technique and suture tape augmentation for acute tibial-sided injuries. Arthrosc Tech 8:e395–e398. https://doi.org/10.1016/j.eats.2018.11.018

    Article  PubMed  PubMed Central  Google Scholar 

  10. Higuchi T, Arai Y, Takamiya H et al (2010) An analysis of the medial patellofemoral ligament length change pattern using open-MRI. Knee Surg Sports Traumatol Arthrosc 18:1470–1475. https://doi.org/10.1007/s00167-010-1043-2

    Article  PubMed  Google Scholar 

  11. Huber C, Zhang Q, Taylor WR et al (2020) Properties and function of the medial patellofemoral ligament: a systematic review. Am J Sports Med 48:754–766. https://doi.org/10.1177/0363546519841304

    Article  PubMed  Google Scholar 

  12. Jaquith BP, Parikh SN (2017) Predictors of recurrent patellar instability in children and adolescents after first-time dislocation. J Pediatr Orthop 37:484–490. https://doi.org/10.1097/BPO.0000000000000674

    Article  PubMed  Google Scholar 

  13. Kaiser D, Trummler L, Götschi T et al (2021) Patellofemoral instability in trochleodysplastic knee joints and the quantitative influence of simulated trochleoplasty - A finite element simulation. Clin Biomech (Bristol, Avon) 81:105216. https://doi.org/10.1016/j.clinbiomech.2020.105216

    Article  PubMed  Google Scholar 

  14. Khemka A, Lord SJ, Doyle Z et al (2016) Minimally invasive medial patellofemoral ligament reconstruction for patellar instability using an artificial ligament: a two year follow-up. Knee 23:261–266. https://doi.org/10.1016/j.knee.2015.07.002

    Article  PubMed  Google Scholar 

  15. Lee KW, Seo D-K, Bae J-Y et al (2022) Usefulness of three-dimensional computed tomography for patellofemoral measurement. Knee Surg Sports Traumatol Arthrosc 30:1423–1429. https://doi.org/10.1007/s00167-021-06624-6

    Article  PubMed  Google Scholar 

  16. Lee PYF, Golding D, Rozewicz S et al (2018) Modern synthetic material is a safe and effective alternative for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:2716–2721. https://doi.org/10.1007/s00167-017-4711-7

    Article  PubMed  Google Scholar 

  17. Lorbach O, Haupert A, Efe T et al (2017) Biomechanical evaluation of MPFL reconstructions: differences in dynamic contact pressure between gracilis and fascia lata graft. Knee Surg Sports Traumatol Arthrosc 25:2502–2510. https://doi.org/10.1007/s00167-016-4005-5

    Article  PubMed  Google Scholar 

  18. Mackay ND, Smith NA, Parsons N et al (2014) Medial patellofemoral ligament reconstruction for patellar dislocation: a systematic review. Orthop J Sports Med 2:2325967114544021. https://doi.org/10.1177/2325967114544021

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mahmood A, Nag H, Srivastava AK (2020) Clinical and electrophysiological assessment of injury to infrapatellar branch(es) of saphenous nerve during anterior cruciate ligament reconstruction using oblique incision for hamstring graft harvest: A prospective study. Knee 27:709–716. https://doi.org/10.1016/j.knee.2020.04.021

    Article  PubMed  Google Scholar 

  20. McDonald LK, Cosic F, Joseph S (2021) The use of the ligament augmentation and reconstruction system for posterior cruciate ligament reconstruction in isolated and multiligament knee injuries: a systematic review. Knee 30:322–336. https://doi.org/10.1016/j.knee.2021.04.008

    Article  PubMed  Google Scholar 

  21. Mehl J, Otto A, Comer B et al (2020) Repair of the medial patellofemoral ligament with suture tape augmentation leads to similar primary contact pressures and joint kinematics like reconstruction with a tendon graft: a biomechanical comparison. Knee Surg Sports Traumatol Arthrosc 28:478–488. https://doi.org/10.1007/s00167-019-05668-z

    Article  PubMed  Google Scholar 

  22. Migliorini F, Marsilio E, Cuozzo F et al (2021) Chondral and soft tissue injuries associated to acute patellar dislocation: a systematic review. Life (Basel). https://doi.org/10.3390/life11121360

    Article  PubMed  Google Scholar 

  23. Migliorini F, Pilone M, Eschweiler J et al (2022) High rates of damage to the medial patellofemoral ligament, lateral trochlea and patellar crest after acute patellar dislocation: MRI analysis. Arthroscopy. https://doi.org/10.1016/j.arthro.2022.01.044

    Article  PubMed  Google Scholar 

  24. Milinkovic DD, Zimmermann F, Balcarek P (2022) Medial patellofemoral ligament reconstruction using nonresorbable sutures yields comparable outcomes to reconstruction with a pedicled quadriceps tendon autograft when performed in addition to bony risk factor correction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07104-1

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mountney J, Senavongse W, Amis AA et al (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Jt Surg Br 87:36–40

    Article  CAS  Google Scholar 

  26. Nomura E, Horiuchi Y, Kihara M (2000) A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation. Knee 7:211–215. https://doi.org/10.1016/s0968-0160(00)00072-7

    Article  CAS  PubMed  Google Scholar 

  27. Philippot R, Boyer B, Testa R et al (2012) Study of patellar kinematics after reconstruction of the medial patellofemoral ligament. Clin Biomech (Bristol, Avon) 27:22–26. https://doi.org/10.1016/j.clinbiomech.2011.08.001

    Article  PubMed  Google Scholar 

  28. Powers CM, Witvrouw E, Davis IS et al (2017) Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th international patellofemoral pain research retreat, Manchester, UK: part 3. Br J Sports Med 51:1713–1723. https://doi.org/10.1136/bjsports-2017-098717

    Article  PubMed  Google Scholar 

  29. Sakamoto Y, Sasaki S, Kimura Y et al (2020) Patellofemoral contact pressure for medial patellofemoral ligament reconstruction using suture tape varies with the knee flexion angle: a biomechanical evaluation. Arthroscopy 36:1390–1395. https://doi.org/10.1016/j.arthro.2019.12.027

    Article  PubMed  Google Scholar 

  30. Sanders TL, Pareek A, Hewett TE et al (2018) High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study. Knee Surg Sports Traumatol Arthrosc 26:1037–1043. https://doi.org/10.1007/s00167-017-4505-y

    Article  PubMed  Google Scholar 

  31. Sappey-Marinier E, Sonnery-Cottet B, O’Loughlin P et al (2019) Clinical outcomes and predictive factors for failure with isolated mpfl reconstruction for recurrent patellar instability: a series of 211 reconstructions with a minimum follow-up of 3 years. Am J Sports Med 47:1323–1330. https://doi.org/10.1177/0363546519838405

    Article  PubMed  Google Scholar 

  32. Schneider DK, Grawe B, Magnussen RA et al (2016) Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations: a systematic review and meta-analysis. Am J Sports Med 44:2993–3005. https://doi.org/10.1177/0363546515624673

    Article  PubMed  PubMed Central  Google Scholar 

  33. Seitlinger G, Scheurecker G, Högler R et al (2012) Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 40:1119–1125. https://doi.org/10.1177/0363546512438762

    Article  PubMed  Google Scholar 

  34. Shah JN, Howard JS, Flanigan DC et al (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40:1916–1923. https://doi.org/10.1177/0363546512442330

    Article  PubMed  PubMed Central  Google Scholar 

  35. Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93–101. https://doi.org/10.1097/BLO.0b013e31802eb40a

    Article  PubMed  Google Scholar 

  36. Stephen JM, Kader D, Lumpaopong P et al (2013) Sectioning the medial patellofemoral ligament alters patellofemoral joint kinematics and contact mechanics. J Orthop Res 31:1423–1429. https://doi.org/10.1002/jor.22371

    Article  PubMed  Google Scholar 

  37. Stephen JM, Kittl C, Williams A et al (2016) Effect of medial patellofemoral ligament reconstruction method on patellofemoral contact pressures and kinematics. Am J Sports Med 44:1186–1194. https://doi.org/10.1177/0363546516631736

    Article  PubMed  Google Scholar 

  38. van Haver A, de Roo K, de Beule M et al (2015) The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am J Sports Med 43:1354–1361. https://doi.org/10.1177/0363546515572143

    Article  PubMed  Google Scholar 

  39. Verhulst FV, van Sambeeck JDP, Olthuis GS et al (2020) Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports Traumatol Arthrosc 28:869–875. https://doi.org/10.1007/s00167-019-05531-1

    Article  PubMed  Google Scholar 

  40. Wierer G, Krabb N, Kaiser P et al (2022) The Patellar instability probability calculator: a multivariate-based model to predict the individual risk of recurrent lateral patellar dislocation. Am J Sports Med 50:471–477. https://doi.org/10.1177/03635465211063176

    Article  PubMed  Google Scholar 

  41. Wisbech Vange S, Tranum-Jensen J, Krogsgaard MR (2020) Gracilis tendon harvest may lead to both incisional and non-incisional saphenous nerve injuries. Knee Surg Sports Traumatol Arthrosc 28:969–974. https://doi.org/10.1007/s00167-019-05605-0

    Article  PubMed  Google Scholar 

  42. Wolfe S, Varacallo M, Thomas JD et al (2022) Patellar instability. In: StatPearls. StatPearls Publishing, Treasure Island

  43. Zaffagnini S, Colle F, Lopomo N et al (2013) The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc 21:2164–2171. https://doi.org/10.1007/s00167-012-2307-9

    Article  PubMed  Google Scholar 

  44. Zhang G-Y, Ding H-Y, Li E-M et al (2019) Incidence of second-time lateral patellar dislocation is associated with anatomic factors, age and injury patterns of medial patellofemoral ligament in first-time lateral patellar dislocation: a prospective magnetic resonance imaging study with 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 27:197–205. https://doi.org/10.1007/s00167-018-5062-8

    Article  PubMed  Google Scholar 

  45. Zimmermann F, Börtlein J, Milinkovic DD et al (2020) Patient-reported outcomes after revision surgery for failed medial patellofemoral ligament reconstruction: a matched-pair analysis including correction of predisposing factors. Am J Sports Med 48:3566–3572. https://doi.org/10.1177/0363546520966354

    Article  PubMed  Google Scholar 

  46. Zimmermann F, Schonhoff M, Jäger S et al (2022) Soft-tissue fixation is not inferior to suture-anchor fixation in reconstruction of the medial patellofemoral ligament using a nonresorbable suture tape. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-07120-1

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Germany

    Felix Zimmermann, Maxim Privalov, Jochen Franke, Paul Alfred Grützner & Sven Y. Vetter

  2. Arcus Sportklinik, Pforzheim, Germany

    Peter Balcarek

  3. Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medicine Göttingen, Göttingen, Germany

    Peter Balcarek

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  1. Felix Zimmermann
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  4. Paul Alfred Grützner
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Contributions

FZ, SYV: study design, data acquisition, data analysis, data interpretation, writing the paper, final approval. MP, JF, PAG: data analysis, data interpretation, final approval. PB: study design, data analysis, data interpretation, writing the paper, final approval.

Corresponding author

Correspondence to Sven Y. Vetter.

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Conflict of interest

PB declares that he has no competing interests. FZ, MP, JF, PAG and SYV are members of the MINTOS research group, who had grants/grants pending and technical support from Siemens Healthineers (Erlangen, Germany) and Nuvasive (SanDiego, USA). PAG and JF are unpaid members of an advisory board for Siemens.

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Ethics approval was given by the local ethics committee (Reference no. 2021-15764_1-andere Forschung erstvotierend).

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Zimmermann, F., Privalov, M., Franke, J. et al. Reconstruction of the medial patellofemoral ligament with nonresorbable suture tape normalizes patellar maltracking independent of patella-side fixation technique. Knee Surg Sports Traumatol Arthrosc 31, 2870–2876 (2023). https://doi.org/10.1007/s00167-022-07256-0

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