Purpose
To investigate the isolated and combined effects of medial patellofemoral ligament
(MPFL) and medial patellotibial ligament (MPTL) deficiency and reconstruction on patellofemoral
kinematics.
Methods
Sixteen matched-paired female cadaveric knee specimens with a mean age of 53.5 years
(range, 26-65) were tested in 5 conditions: (1) intact, (2) MPFL or MPTL cut, (3)
MPFL and MPTL combined cut, (4) MPFL or MPTL reconstruction, and (5) MPFL and MPTL
combined reconstruction. Dynamic testing allowed continuous analysis of kinematics
from 0° to 90° of knee flexion. Knees were also tested statically using a lateral
load of 45 N at 0°, 30°, 60°, and 90° of flexion. In both dynamic and static loading
tests, a motion capture system detected patellar position for each testing state to
distinguish changes in patellar kinematics. Random-intercepts linear mixed-effects
models were used to compare patellar kinematics.
Results
The MPFL is the primary restraint to lateral translation of the patella at all knee
flexion angles. MPTL deficiency alone did not create significant patella instability,
but further increased instability when the MPFL was deficient. Isolated MPFL and combined
reconstruction provided improved stability. Through full range of motion native patella
tracking was best recreated with combined ligament reconstruction.
Conclusions
The MPFL plays the greatest role in medial patellar stability, but the MPTL appears
to have an influence on patella tracking. This study provides further understanding
to the impact of the MPFL and MPTL on patellofemoral motion with implications for
reconstruction to improve stability and optimize patellofemoral tracking.
Clinical Relevance
This study provides further understanding of the role of the MPFL and MPTL on patellofemoral
motion with implications for reconstruction to improve stability and optimize patellofemoral
tracking.
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Article Info
Publication History
Published online: May 19, 2020
Accepted:
May 11,
2020
Received:
December 24,
2019
See commentary on page 2510Footnotes
The authors report the following potential conflicts of interest or sources of funding: R.F.L. receives royalties from Arthrex , Ossur, and Smith & Nephew; is a paid consultant for Arthrex , Ossur, Linvatec, and Smith & Nephew; receives research support from Arthrex, Linvatec , Ossur , and Smith & Nephew ; is on the editorial/governing board of AJSM, JEO, and KSSTA; and has membership/committee appointments for AOSSM, ISAKOS, AANA, and ESSKA. W.J.G. received educational funding from Smith & Nephew . Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Investigation performed at the Department of Biomedical Engineering, Steadman Philippon Research Institute, Vail, CO.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
