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Original Article| Volume 36, ISSUE 6, P1670-1676, June 2020

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Differential Contributions of the Quadriceps and Patellar Attachments of the Proximal Medial Patellar Restraints to Resisting Lateral Patellar Translation

Published:February 13, 2020DOI:https://doi.org/10.1016/j.arthro.2020.01.058
Differential Contributions of the Quadriceps and Patellar Attachments of the Proximal Medial Patellar Restraints to Resisting Lateral Patellar Translation
Previous ArticleEditorial Commentary: Measurements for Successful High Tibial Osteotomy: Understanding Supine Versus Standing and Intraoperative Fluoroscopic Alignment Is Required
Next ArticleEditorial Commentary: The Best Medial Patellofemoral Reconstruction May Include Components of Both Quadriceps and Patellar Attachments

      Purpose

      To define the contributions of the of the medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL) to lateral patellar translation as the knee moves through a 90° arc of motion.

      Methods

      Six pairs of bilateral cadaveric knee specimens (12 knees) were dissected and potted in perfect lateral position using fluoroscopy. An eye screw was placed in the midpoint on the lateral aspect of the patella. Each knee underwent testing in 4 conditions after sequential sectioning: intact, lateral retinacular release, randomized MQTFL or MPFL sectioning, and complete proximal medial patellar restraint (PMPR) sectioning. With a custom machined jig, all knees were tested at 0, 10, 20, 30, 45, 60, and 90° of flexion on an MTS machine with 20N of lateral patellar force applied and displacement recorded.

      Results

      PMPR extensor mechanism insertion on all specimens was identified 50% on the quadriceps tendon and 50% on the proximal aspect of the medial patella. Isolated MPFL sectioning resulted in significantly increased lateral displacement compared to the lateral release state at all flexion angles tested except 0°. There was significantly increased lateral patellar displacement with complete sectioning compared with isolated proximal sectioning at all degrees of knee flexion except 0°. However, complete sectioning following isolated MPFL sectioning did not demonstrate significance at any angle.

      Conclusions

      Compared with the MQTFL, the MPFL is primarily responsible for resistance to lateral patellar translation throughout a 0° to 90° arc of motion. The MPFL provides a similar resistance to lateral patellar displacement as the fully intact PMPR; however, the MQTFL may contribute to resistance in full extension.

      Clinical Significance

      Proximal medial patellar restraint reconstruction techniques involving both the patellar and quadriceps insertion have been described; however, the unique contributions of the native anatomy to lateral patellar restraint have not been investigated.
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      Article info

      Publication history

      Published online: February 13, 2020
      Accepted: January 31, 2020
      Received: April 26, 2019

      Footnotes

      See commentary on page 1677

      The authors report the following potential conflict of interest or source of funding: B.J.C. reports other from Aesculap/B. Braun, other from American Journal of Orthopedics, other from American Journal of Sports Medicine, personal fees and other from Arthrex, other from Arthroscopy Association of North America, other from Athletico, other from Cartilage, other from Elsevier Publishing, other from International Cartilage Repair Society, other from Journal of Shoulder and Elbow Surgery, other from Journal of the American Academy of Orthopaedic Surgeons, other from JRF Ortho, other from National Institutes of Health, other from Operative Techniques in Sports Medicine, other from Ossio, personal fees and other from Regentis, and other from Smith & Nephew, outside the submitted work. A.B.Y. reports grants from the Arthroscopy Association of North America, during the conduct of the study; and personal fees from JRF Ortho, other from Arthrex, other from Organogenesis, outside the submitted work. J.F. reports personal fees and other from Active Implants, other from the American Journal of Orthopaedics, personal fees from Arthrex, personal fees from Cartiheal, other from Cartilage, personal fees from Exactech, other from Fidia, other from MedShape, personal fees and other from Moximed, other from Novartis, personal fees and other from Organogenesis, other from Ortho Regenerative Tech, personal fees from Regentis, personal fees from Samumed, personal fees and other from Springer, personal fees and other from Thieme Medical Publishers, personal fees from Vericel, other from Zimmer Biomet, and personal fees from Zipline, outside the submitted work. This study was performed using funding received from an Arthroscopy Association of North America 2018 Research Grant. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

      Identification

      DOI: https://doi.org/10.1016/j.arthro.2020.01.058

      Copyright

      © 2020 by the Arthroscopy Association of North America

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