Strain behavior of native and reconstructed medial patellofemoral ligaments during dynamic knee flexion - a cadaveric study

Mohamed Buhary Kizher Shajahan,Hiok Yang Chan,Tjiauw Tjoen Denny Lie,Suang Bee Joyce Koh,Tet Sen Howe,Khye Soon Andy Yew,Chee Cheng Paul Chang,Chaw Tat Alex Choh

doi:10.1186/s40634-019-0195-3

Mohamed Buhary Kizher Shajahan, Hiok Yang Chan + Show 6 more

Open Access

https://doi.org/10.1186/s40634-019-0195-3

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Abstract

BackgroundSurgical reconstruction of the Medial Patello-Femoral Ligament (MPFL) has been recognized as an effective treatment for patients with instability despite conservative treatment. The purpose of this cadaveric study is to compare the strain patterns within the native and reconstructed single and double-bundle MPFL. This will help ascertain if the native biomechanics are restored with the reconstructions.MethodsTwelve cadaveric knees were dissected and the native MPFL of each specimen was identified. The knees were subjected to dynamic flexion using a customized jig. Continuous strain measurements were taken for each knee from 0 to 120 degrees flexion and then back to full extension using differential variable reluctance transducers (DVRTs). The MPFL was then cut. Six single bundle and six double bundle MPFL reconstructions were performed using hamstring tendon grafts. The DVRTs were reattached to the grafts and strain measurements were retaken. Statistical analysis was performed using a paired t-test.ResultsStrain patterns of the native and reconstructed MPFL showed an increase in strain from 0 to 120 degrees of flexion except for the inferior bundle of the double bundle reconstruction. The strain patterns in the intact specimens were higher than the reconstructed MPFL through different degrees of knee flexion. In the double-bundle group, the superior graft had statistically significantly lower strains compared to the native MPFL with p-value <.05 at all flexion angles. The reconstructed inferior band showed loss of tension as the knee flexed. Higher strain with statistical significance (p-value <.05) was found in the single-bundle compared to the superior band of the double-bundle reconstruction at flexion angles less than 90 degrees.ConclusionThe strain variation at progressive angles of knee flexion is dissimilar between the native and reconstructed MPFL. The reconstructed MPFL exhibited non-physiological biomechanics with the inferior band losing tension. Although the single-bundle reconstruction shows a better strain profile compared to double-bundle reconstruction, the grafts are significantly stiffer than the native MPFL.

Highlights

Surgical reconstruction of the Medial Patello-Femoral Ligament (MPFL) has been recognized as an effective treatment for patients with instability despite conservative treatment
It was observed that the MPFL strain in both the superior and inferior aspects increased as the knee was flexed and peaked at 105 degrees of flexion
The strain over the superior aspect of the intact MPFL was more than the inferior aspect of the intact MPFL in all degrees of flexion

Summary

Introduction

Surgical reconstruction of the Medial Patello-Femoral Ligament (MPFL) has been recognized as an effective treatment for patients with instability despite conservative treatment. The purpose of this cadaveric study is to compare the strain patterns within the native and reconstructed single and double-bundle MPFL. In full extension of the knee, the patella sits anterior to the distal femur, with only the distal pole of the patella in contact with the superior trochlea groove At this time, the medial patellofemoral ligament (MPFL) is taut and prevents lateral subluxation of the patella (Philippot et al 2009). The lateral femoral condyle and medial soft tissue stabilizers prevent lateral subluxation of the patella. (Alemparte et al 2007; Tuxoe et al 2002)

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