Landmarks to guide femoral insertion in lateral patellofemoral ligament reconstruction: An in vivo assessment of isometry.

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-02-24 DOI:10.1002/ksa.12635

Miriam R Boot, Sebastiaan A W van de Groes, Esther Tanck, Dennis Janssen

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引用次数: 0

Abstract

Purpose: Lateral patellofemoral ligament (LPFL) reconstruction addresses medial patellar instability, but uncertainty regarding the optimal femoral attachment site may affect isometry and increase complication rates. This study aimed to establish landmarks for the femoral attachment of the LPFL graft based on in vivo isometry during active knee extension.

Methods: Dynamic computed tomography scans of 104 knees from 58 healthy participants were employed to examine flexion-extension movements. Length changes were assessed in approximately 1335 virtual LPFL graft fibres, which extended from the proximal one third of the patellar height to attachments across the femoral condyle. Four methods were evaluated for achieving (near-)isometric LPFL graft behaviour: three radiographic methods (R1-R3) and one anatomic method (A). Method R1 positioned the femoral attachment at a lateral equivalent of Schöttle's point, Method R2 at the centre of the trochlear groove arc, Method R3 at the centre of the lateral trochlear ridge arc and Method A at a point relative to the lateral epicondyle.

Results: Median length changes during extension were 7.7 mm (Method R1), 3.4 mm (Method R2), 2.7 mm (Method R3) and 3.0 mm (Method A). Method R3 demonstrated significantly smaller length changes compared to Methods R1 (p < 0.001) and R2 (p < 0.01), while Method A yielded smaller changes than Method R1 (p < 0.001). Notably, Method R1 resulted in continuous LPFL graft tightening throughout knee motion, whereas Methods R2, R3 and A showed initial tightening until 20° flexion, followed by slackening and near-isometric behaviour.

Conclusion: Femoral graft attachment is best determined at the centre of the lateral trochlear ridge arc (Method R3) or 15.1 mm anterior and 3.4 mm proximal to the lateral epicondyle (Method A). These guidelines help improve surgical precision and minimize complications in LPFL reconstructions.

Level of evidence: Level III.

查看原文本刊更多论文

髌股外侧韧带重建中指导股骨插入的标志：体内等距性评估。

目的：外侧髌股韧带（LPFL）重建解决髌骨内侧不稳定，但股骨最佳附着位置的不确定性可能影响等距和增加并发症发生率。本研究旨在基于主动膝关节伸展时的体内等距测量，建立LPFL移植物股骨附着的标志。方法：对58名健康参与者的104个膝关节进行动态计算机断层扫描，以检查屈伸运动。评估了大约1335个虚拟LPFL移植物纤维的长度变化，这些纤维从近端髌骨高度的三分之一延伸到股骨髁的附着物。评估了实现（近）等距LPFL移植物行为的四种方法：三种放射学方法（R1-R3）和一种解剖学方法(A)。方法R1将股骨附着体定位在相当于Schöttle的外侧点，方法R2定位在滑车沟弧的中心，方法R3定位在滑车外侧脊弧的中心，方法A定位在相对于外侧上髁的点。结果：伸展术中位长度变化分别为7.7 mm （R1法）、3.4 mm （R2法）、2.7 mm （R3法）和3.0 mm （A法），其中R3法的长度变化明显小于R1法(p)。股骨移植物最好在滑车外侧脊弧中心（方法R3）或外侧上髁前15.1 mm和近3.4 mm处（方法A）确定附着。这些指南有助于提高手术精度并减少LPFL重建的并发症。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).