Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage

A computational analysis

Research output: Contribution to journalArticle

Abstract

Background: The influence of reconstruction of the medial patellofemoral ligament on the patellofemoral force and pressure distributions has not yet been investigated. Hypothesis: Technical errors can cause tension to develop within a reconstructed medial patellofemoral ligament, which will adversely alter the normal patellofemoral force distribution by increasing the load applied to the medial cartilage. Study Design: Controlled laboratory study. Methods: Four computational knee models were used to simulate knee function from 30° to 90° of flexion with (1) an intact medial patellofemoral ligament, (2) an anatomically correct reconstruction using a double hamstring tendon autograft, (3) a 5-mm proximally malpositioned femoral attachment site, (4) a graft that is 3 mm shorter than the intact medial patellofemoral ligament, and (5) combined proximal malpositioning and a short graft. Results: The results were similar for the intact and anatomically reconstructed medial patellofemoral ligament. Proximal malpositioning of the femoral attachment and using a short graft increased the graft tension during flexion, which decreased the lateral force and the lateral tilt moment acting on the patella. When a short graft was combined with proximal malpositioning, the compressive force applied to the medial cartilage at least doubled at low flexion angles, which increased the peak medial pressure by more than 50% at low flexion angles. Conclusion: When the medial patellofemoral ligament is reconstructed, small errors in graft length and position can dramatically increase the force and pressure applied to medial patellofemoral cartilage. Clinical Relevance: Overloading the medial cartilage after medial patellofemoral ligament reconstruction could lead to degradation, pain, and arthrosis.

Original languageEnglish (US)
Pages (from-to)1478-1485
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume34
Issue number9
DOIs
StatePublished - Sep 2006

Fingerprint

Ligaments
Cartilage
Transplants
Thigh
Pressure
Knee
Patella
Joint Diseases
Autografts
Pain

Keywords

  • Cartilage
  • Dislocation
  • Medial patellofemoral ligament (MPFL)
  • Patella
  • Pressure
  • Reconstruction

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

@article{0d8ba29cdb6044a8810519318714362c,
title = "Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: A computational analysis",
abstract = "Background: The influence of reconstruction of the medial patellofemoral ligament on the patellofemoral force and pressure distributions has not yet been investigated. Hypothesis: Technical errors can cause tension to develop within a reconstructed medial patellofemoral ligament, which will adversely alter the normal patellofemoral force distribution by increasing the load applied to the medial cartilage. Study Design: Controlled laboratory study. Methods: Four computational knee models were used to simulate knee function from 30° to 90° of flexion with (1) an intact medial patellofemoral ligament, (2) an anatomically correct reconstruction using a double hamstring tendon autograft, (3) a 5-mm proximally malpositioned femoral attachment site, (4) a graft that is 3 mm shorter than the intact medial patellofemoral ligament, and (5) combined proximal malpositioning and a short graft. Results: The results were similar for the intact and anatomically reconstructed medial patellofemoral ligament. Proximal malpositioning of the femoral attachment and using a short graft increased the graft tension during flexion, which decreased the lateral force and the lateral tilt moment acting on the patella. When a short graft was combined with proximal malpositioning, the compressive force applied to the medial cartilage at least doubled at low flexion angles, which increased the peak medial pressure by more than 50{\%} at low flexion angles. Conclusion: When the medial patellofemoral ligament is reconstructed, small errors in graft length and position can dramatically increase the force and pressure applied to medial patellofemoral cartilage. Clinical Relevance: Overloading the medial cartilage after medial patellofemoral ligament reconstruction could lead to degradation, pain, and arthrosis.",
keywords = "Cartilage, Dislocation, Medial patellofemoral ligament (MPFL), Patella, Pressure, Reconstruction",
author = "Elias, {John Joseph} and Cosgarea, {Andrew J}",
year = "2006",
month = "9",
doi = "10.1177/0363546506287486",
language = "English (US)",
volume = "34",
pages = "1478--1485",
journal = "American Journal of Sports Medicine",
issn = "0363-5465",
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number = "9",

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TY - JOUR

T1 - Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage

T2 - A computational analysis

AU - Elias, John Joseph

AU - Cosgarea, Andrew J

PY - 2006/9

Y1 - 2006/9

N2 - Background: The influence of reconstruction of the medial patellofemoral ligament on the patellofemoral force and pressure distributions has not yet been investigated. Hypothesis: Technical errors can cause tension to develop within a reconstructed medial patellofemoral ligament, which will adversely alter the normal patellofemoral force distribution by increasing the load applied to the medial cartilage. Study Design: Controlled laboratory study. Methods: Four computational knee models were used to simulate knee function from 30° to 90° of flexion with (1) an intact medial patellofemoral ligament, (2) an anatomically correct reconstruction using a double hamstring tendon autograft, (3) a 5-mm proximally malpositioned femoral attachment site, (4) a graft that is 3 mm shorter than the intact medial patellofemoral ligament, and (5) combined proximal malpositioning and a short graft. Results: The results were similar for the intact and anatomically reconstructed medial patellofemoral ligament. Proximal malpositioning of the femoral attachment and using a short graft increased the graft tension during flexion, which decreased the lateral force and the lateral tilt moment acting on the patella. When a short graft was combined with proximal malpositioning, the compressive force applied to the medial cartilage at least doubled at low flexion angles, which increased the peak medial pressure by more than 50% at low flexion angles. Conclusion: When the medial patellofemoral ligament is reconstructed, small errors in graft length and position can dramatically increase the force and pressure applied to medial patellofemoral cartilage. Clinical Relevance: Overloading the medial cartilage after medial patellofemoral ligament reconstruction could lead to degradation, pain, and arthrosis.

AB - Background: The influence of reconstruction of the medial patellofemoral ligament on the patellofemoral force and pressure distributions has not yet been investigated. Hypothesis: Technical errors can cause tension to develop within a reconstructed medial patellofemoral ligament, which will adversely alter the normal patellofemoral force distribution by increasing the load applied to the medial cartilage. Study Design: Controlled laboratory study. Methods: Four computational knee models were used to simulate knee function from 30° to 90° of flexion with (1) an intact medial patellofemoral ligament, (2) an anatomically correct reconstruction using a double hamstring tendon autograft, (3) a 5-mm proximally malpositioned femoral attachment site, (4) a graft that is 3 mm shorter than the intact medial patellofemoral ligament, and (5) combined proximal malpositioning and a short graft. Results: The results were similar for the intact and anatomically reconstructed medial patellofemoral ligament. Proximal malpositioning of the femoral attachment and using a short graft increased the graft tension during flexion, which decreased the lateral force and the lateral tilt moment acting on the patella. When a short graft was combined with proximal malpositioning, the compressive force applied to the medial cartilage at least doubled at low flexion angles, which increased the peak medial pressure by more than 50% at low flexion angles. Conclusion: When the medial patellofemoral ligament is reconstructed, small errors in graft length and position can dramatically increase the force and pressure applied to medial patellofemoral cartilage. Clinical Relevance: Overloading the medial cartilage after medial patellofemoral ligament reconstruction could lead to degradation, pain, and arthrosis.

KW - Cartilage

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KW - Patella

KW - Pressure

KW - Reconstruction

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