Influence of the Fluoroscopy Setting towards the Patient When Identifying the MPFL Insertion Point

Korthaus, Alexander; Dust, Tobias; Berninger, Markus T.; Frings, Jannik; Krause, Matthias; Frosch, Karl‐Heinz; Thürig, Grégoire

doi:10.3390/diagnostics12061427

Cited by 4 publications

(2 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Double-bundle anatomic MPFLR was performed using the ipsilateral gracilis tendon. The femoral tunnel was positioned with reference to the osseous landmarks between the medial femoral epicondyle and the adductor tubercle and was verified with fluoroscopy according to the method described by Schöttle et al [27]. Two patellar tunnels were drilled in the upper corner and the center of the medial edge of the patella.…”

Section: Surgical Procedures and Postoperative Rehabilitationmentioning

confidence: 99%

The thickness change ratio and preservation ratio of the infrapatellar fat pad are related to anterior knee pain in patients following medial patellofemoral ligament reconstruction

Huo,

Xu,

et al. 2024

J Orthop Surg Res

View full text Add to dashboard Cite

Background The infrapatellar fat pad (IPFP) lies extrasynovial and intracapsular, preserving the joint cavity and serving as a biochemical regulator of inflammatory reactions. However, there is a lack of research on the relationship between anterior knee pain (AKP) and the IPFP after medial patellofemoral ligament reconstruction (MPFLR). Pinpointing the source of pain enables clinicians to promptly manage and intervene, facilitating personalized rehabilitation and improving patient prognosis. Methods A total of 181 patients were included in the study. These patients were divided into the AKP group (n = 37) and the control group (n = 144). Clinical outcomes included three pain-related scores, Tegner activity score, patient satisfaction, etc. Imaging outcomes included the IPFP thickness, IPFP fibrosis, and the IPFP thickness change and preservation ratio. Multivariate analysis was used to determine the independent factors associated with AKP. Finally, the correlation between independent factors and three pain-related scores was analyzed to verify the results. Results The control group had better postoperative pain-related scores and Tegner activity score than the AKP group (P < 0.01). The AKP group had lower IPFP thickness change ratio and preservation ratio (P < 0.001), and smaller IPFP thickness (P < 0.05). The multivariate analysis revealed that the IPFP thickness change ratio [OR = 0.895, P < 0.001] and the IPFP preservation ratio [OR = 0.389, P < 0.001] were independent factors related to AKP, with a significant correlation between these factors and pain-related scores [|r| > 0.50, P < 0.01]. Conclusions This study showed the lower IPFP change ratio and preservation ratio may be independent factors associated with AKP after MPFLR. Early detection and targeted intervention of the underlying pain sources can pave the way for tailored rehabilitation programs and improved surgical outcomes. Level of evidence Level III

show abstract

Section: Surgical Procedures and Postoperative Rehabilitationmentioning

confidence: 99%

The thickness change ratio and preservation ratio of the infrapatellar fat pad are related to anterior knee pain in patients following medial patellofemoral ligament reconstruction

Huo,

Xu,

et al. 2024

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…A double‐bundle anatomic MPFL reconstruction was performed using autologous semitendinosus. Intraoperative fluoroscopy was used to determine the femoral insertion point by the Schottle method [15]. Two tunnels were drilled in the upper corner and the center of the medial edge of the patella.…”

Section: Surgical Techniquementioning

confidence: 99%

Derotational distal femur osteotomy combined with medial patellofemoral ligament reconstruction yields satisfactory results in recurrent patellar dislocation with excessive femoral anteversion angle and trochlear dysplasia

Zhou

Sun

Feng

et al. 2023

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

Purpose The purpose of this study was to evaluate the clinical outcomes of medial patellofemoral ligament (MPFL) reconstruction combined with derotational distal femur osteotomy in patients with recurrent patellar dislocation who had excessive femoral anteversion angle and trochlear dysplasia. Methods Between 2015 and 2020, 64 patients (64 knees) with recurrent patellar dislocation, who had excessive femoral anteversion angle (≥ 25°) and trochlear dysplasia and were surgically treated using derotational distal femur osteotomy and MPFL reconstruction, were eligible for this retrospective study. These patients were assigned to two groups according to the grade of trochlear dysplasia. Group A (type A trochlear dysplasia, n = 33) and Group B (type B, C, D trochlear dysplasia, n = 31). Preoperative and postoperative patellar tilt angle (PTA), Caton–Deschamps index (CD‐I), tibial tubercle–trochlear groove (TT–TG) distance and femoral anteversion angle were evaluated. Patient outcomes were assessed using the preoperative and postoperative International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, Tegner score, and visual analog scale (VAS) score. Results A total of 64 patients (64 knees) were evaluated in this study, with a mean follow‐up period of 28.4 ± 3.6 months. There were no cases of wound infection, osteotomy site fractures, deep venous thrombosis of the lower extremities, or re‐dislocation in the two groups during the postoperative follow‐up period. All patients returned to full extension and flexion. The postoperative Tegner score, Lysholm score, Kujala score, IKDC score, VAS score, PTA, CD‐I, TT–TG distance, and femoral anteversion angle were significantly improved compared with the preoperative status (P < 0.05). There was no significant difference between the two groups (n.s.). Conclusion MPFL reconstruction combined with derotational distal femur osteotomy showed satisfactory clinical outcomes during follow‐up in patients with recurrent patellar dislocation who had excessive femoral anteversion angle and trochlear dysplasia. Even patients with high‐grade trochlear dysplasia showed satisfactory results. For those patients, additional surgery is not necessary. Level of evidence Level III.

show abstract

Lateral to medial fluoroscopic view improves the accuracy of identifying the MPFL femoral footprint using Schottle's technique

Cetin,

Kose,

Selcuk

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

PurposeThis study investigated the effect of different fluoroscopy settings on the accuracy of locating Schottle's point during medial patellofemoral ligament (MPFL) reconstruction.MethodsThe centre of the MPFL femoral footprint was identified and marked on 44 dry femurs. Two standard true lateral knee fluoroscopic images were obtained: (1) medial to lateral (ML) and (2) lateral to medial (LM). The deviation between the anatomically determined MPFL femoral footprint and the fluoroscopically identified point was measured on both fluoroscopic images. An ‘acceptable tunnel location’ was defined as within a 5‐ or 7‐mm margin of error from the anatomic MPFL footprint. Distal femoral morphometric dimensions were also measured using digital calipers. Statistical analysis determined discrepancies between techniques and their relation to femoral morphometry.ResultsThe LM view yielded a significantly smaller distance between the anatomical MPFL footprint and Schottle's point compared to the ML view (3.2 ± 1.5 vs. 4.5 ± 2.1 mm, p < 0.001). The LM view achieved acceptable tunnel locations, meeting the 5‐mm error criterion in 90.9% of cases, while the ML view achieved 65.9% (p < 0.001). Both views yielded acceptable tunnel locations at similar rates using the 7‐mm error criterion (n.s.). The anatomic MPFL footprint was displaced towards the anterior and proximal location in the ML view in reference to the Schottle point. No correlation was observed between any of the morphometric measurements and the deviations.ConclusionsThis study demonstrated that using the LM fluoroscopic view improves the accuracy of femoral tunnel placement when identifying the MPFL footprint via the Schottle technique. Adopting the LM view in surgical practice will help surgeons locate the anatomical femoral footprint accurately, replicating the native MPFL and enhancing clinical outcomes.Level of EvidenceLevel 4, cadaveric study.

show abstract

Influence of the Fluoroscopy Setting towards the Patient When Identifying the MPFL Insertion Point

Cited by 4 publications

References 41 publications

The thickness change ratio and preservation ratio of the infrapatellar fat pad are related to anterior knee pain in patients following medial patellofemoral ligament reconstruction

The thickness change ratio and preservation ratio of the infrapatellar fat pad are related to anterior knee pain in patients following medial patellofemoral ligament reconstruction

Derotational distal femur osteotomy combined with medial patellofemoral ligament reconstruction yields satisfactory results in recurrent patellar dislocation with excessive femoral anteversion angle and trochlear dysplasia

Lateral to medial fluoroscopic view improves the accuracy of identifying the MPFL femoral footprint using Schottle's technique

Contact Info

Product

Resources

About