In vitro measurement of patellar kinematics following reconstruction of the medial patellofemoral ligament

Abstract

This study compares the effects of two different techniques of medial patellofemoral ligament (MPFL) reconstruction, and proximal soft tissue realignment on patellar stabilization against lateral dislocation. Eight human cadaver knee specimens with no radiological pathomorpholgy on a straight lateral view, contributing to patellofemoral instability, were mounted in a kinematic knee simulator and isokinetic extension was simulated. Patellar kinematics were measured with an ultrasound positioning system (zebris) while a 100 N laterally directed force was applied to the patella. The kinematics were compared with intact knee conditions under MPFL deficient conditions, as well as following dynamic reconstruction of the MPFL using a distal transfer of the semitendinosus tendon, following static reconstruction by a semitendinosus autograft, and following proximal soft tissue realignment of the patella (Insall procedure). Dynamic reconstruction of the MPFL resulted in no significant alteration (P = 0.16) of patellar kinematics. Static reconstruction of the MPFL significantly medialized (P < 0.01) the patellar movement without, but restored intact knee kinematics under the laterally directed force. In contrast, following proximal soft tissue realignment, the patellar movement was constantly medialized and internally tilted (P = 0.04). Dynamic and static reconstruction of the MPFL create sufficient stabilization of the patella. Following proximal soft tissue realignment, the patellar position was over-medialized relative to intact knee conditions, which could lead to an overuse of the medial retropatellar cartilage.