Length Change Behavior of Virtual Medial Patellofemoral Ligament Fibers During In Vivo Knee Flexion

Song, Si Young; Pang, Chae-Hyun; Kim, Chan Hyoek; Kim, Jeehyoung; Choi, Mi Lim; Seo, Young-­Jin

doi:10.1177/0363546514567061

Cited by 30 publications

(45 citation statements)

References 36 publications

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“…Our findings confirm that the MPFL is not a fully isometric structure [9,13]. We measured a considerable length change with a maximal string length difference throughout full range of motion of 9.8 mm for string I and 7.2 mm for string II.…”

Section: Discussionsupporting

confidence: 82%

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Femoral insertion site in medial patellofemoral ligament reconstruction

et al. 2016

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Section: Discussionsupporting

confidence: 82%

“…This anatomic structure represents an important passive stabilizer in early flexion degrees in patellofemoral joint kinematics [9][10][11][12][13]; it prohibits the patella from being laterally misrouted near knee extension in the proximal, mostly dysplastic, trochlear portion.…”

Section: Introductionmentioning

confidence: 99%

Femoral insertion site in medial patellofemoral ligament reconstruction

et al. 2016

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“…9) [30,33,39] in passive knee flexion. Thereby, the validity of our musculoskeletal model and the reliability of the multibody simulation could be verified.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, both groups defined optimal insertion points for MPFL reconstruction and highlighted the importance of anatomical insertion. The calculation of MPFL length change pattern with respect to five patellar insertions and the anatomic femoral insertion point was investigated in detail [30]. Furthermore, it has been tried to transfer the computation of the optimal MPFL length change pattern into clinical practice in order to find the ideal, patient-specific femoral attachment point [22].…”

Section: Introductionmentioning

confidence: 99%

Impact of the patella height on the strain pattern of the medial patellofemoral ligament after reconstruction: a computer model-based study

Tischer

Geier

Lenz

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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When reconstructed in the radiological femoral insertion point, MPFL strain patterns were only slightly affected by different patella heights (IS 0.74-1.5) suggesting that MPFL reconstruction could be safely performed using the radiological insertion. However, in case of a patella alta (IS 1.5), a slightly more proximal femoral insertion is beneficial for the biomechanical behaviour of the reconstructed MPFL.

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“…Similar studies using computational models reconstructed from imaging data of subjects indicated that graft tension would be expected to decrease with flexion, 29 decrease in early flexion followed by an increase, 30 or increase in early flexion followed by a decrease. 31 The studies based on path length between graft attachment points did not account for all of the anatomical factors that contribute to patellar instability or patellar glide allowed intraoperatively.…”

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confidence: 99%

Factors Influencing Graft Function following MPFL Reconstruction: A Dynamic Simulation Study

et al. 2020

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Medial patellofemoral ligament (MPFL) reconstruction is currently the primary surgical procedure for treating recurrent lateral patellar instability. The understanding of graft function has largely been based on studies performed with normal knees. The current study was performed to characterize graft function following MPFL reconstruction, focusing on the influence of pathologic anatomy on graft tension, variations with knee flexion, and the influence on patellar tracking. Knee squatting was simulated with 15 multibody dynamic simulation models representing knees being treated for recurrent lateral patellar instability. Squatting was simulated in a preoperative condition and following MPFL reconstruction with a hamstrings tendon graft set to allow 0.5 quadrants of lateral patellar translation with the knee at 30 degrees of flexion. Linear regressions were performed to relate maximum tension in the graft to parameters of knee anatomy. Repeated measures comparisons evaluated variations in patellar tracking at 5-degree increments of knee flexion. Maximum graft tension was significantly correlated with a parameter characterizing lateral position of the tibial tuberosity (maximum lateral tibial tuberosity to posterior cruciate ligament attachment distance, r 2 = 0.73, p < 0.001). No significant correlations were identified for parameters related to trochlear dysplasia (lateral trochlear inclination) or patella alta (Caton–Deschamps index and patellotrochlear index). Graft tension peaked at low flexion angles and was minimal by 30 degrees of flexion. MPFL reconstruction decreased lateral patellar shift (bisect offset index) compared with preoperative tracking at all flexion angles from 0 to 50 degrees of flexion, except 45 degrees. At 0 degrees, the average bisect offset index decreased from 0.81 for the preoperative condition to 0.71. The results indicate that tension within an MPFL graft increases with the lateral position of the tibial tuberosity. The graft tension peaks at low flexion angles and decreases lateral patellar maltracking. The factors that influence graft function following MPFL reconstruction need to be understood to limit patellar maltracking without overloading the graft or over constraining the patella.

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Length Change Behavior of Virtual Medial Patellofemoral Ligament Fibers During In Vivo Knee Flexion

Abstract: The results for lengths and length change patterns of various MPFL fibers are expected to serve as a theoretical background for anatomic double-bundle MPFL reconstruction.

Cited by 30 publications

References 36 publications

Femoral insertion site in medial patellofemoral ligament reconstruction

Femoral insertion site in medial patellofemoral ligament reconstruction

Impact of the patella height on the strain pattern of the medial patellofemoral ligament after reconstruction: a computer model-based study

Factors Influencing Graft Function following MPFL Reconstruction: A Dynamic Simulation Study

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