Abstract
BackgroundCurrently, there is uncertainty regarding the long-term outcome of medial patellofemoral ligament reconstructions (MPFLr). Our objectives were: (1) to develop a parametric model of the patellofemoral joint (PFJ) enabling us to simulate different surgical techniques for MPFLr; (2) to determine the negative effects on the PFJ associated with each technique, which could be related to long-term deterioration of the PFJ.MethodsA finite element model of the PFJ was created based on CT data from 24 knees with chronic lateral patellar instability. Patella contact pressure and maximum MPFL-graft stress at five angles of knee flexion (0, 30, 60, 90 and 120°) were analysed in three types of MPFLr: anatomic, non-anatomic with physiometric behaviour, and non-anatomic with non-physiometric behaviour.ResultsAn increase in patella contact pressure was observed at 0 and 30° of knee flexion after both anatomic and non-anatomic MPFLr with physiometric behaviour. In both reconstructions, the ligament was tense between 0 and 30° of knee flexion, but at 60, 90 and 120°, it had no tension. In the third reconstruction, the behaviour was completely the opposite.ConclusionA parametric model of the PFJ enables us to evaluate different types of MPFLr throughout the full range of motion of the knee, regarding the effect on the patellofemoral contact pressure, as well as the kinematic behaviour of the MPFL-graft and the maximum MPFL-graft stress.
Highlights
There is uncertainty regarding the long-term outcome of medial patellofemoral ligament reconstructions (MPFLr)
Parametric finite element model of the patellofemoral joint From a previous study (Sanchis-Alfonso et al 2017), high spatial resolution Computerized Tomography (CT) data were available from 24 knees of patients with chronic lateral patellar instability
In a knee with a virtual intact Medial patellofemoral (MPFL), which was used as a reference for the comparison among different reconstruction techniques, the maximum patellar cartilage
Summary
There is uncertainty regarding the long-term outcome of medial patellofemoral ligament reconstructions (MPFLr). An effective way to evaluate patellofemoral contact pressure throughout the range of motion of the knee after MPFLr is by using the Finite element methodology (FEM) (DeVries et al 2015; Elias et al 2005; Elias and Cosgarea 2006; Shah et al 2015). This technology enables us to evaluate the kinematic behaviour of the MPFLgraft and maximum MPFL-graft stress, that is, the tension that the graft can withstand before breaking, in all knee flexion-extension positions
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