Wierer Guido, Winkler Philipp W, Pomwenger Werner, Plachel Fabian, Moroder Philipp, Seitlinger Gerd
Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria.
Knee Surg Sports Traumatol Arthrosc. 2022 May;30(5):1620-1628. doi: 10.1007/s00167-021-06682-w. Epub 2021 Jul 31.
(1) To determine applied patellar drilling techniques for medial patellofemoral ligament (MPFL) reconstruction among members of the International Patellofemoral Study Group (IPSG) and (2) to evaluate the risk of patellar fracture for various patellar bone tunnel locations based on a finite element analysis (FEA) model.
In the first part of the study, an online survey on current MPFL reconstruction techniques was conducted among members of the IPSG. In the second part of the study, a three-dimensional FEA model of a healthy knee joint was created using a computed tomography scan. Patient-specific bone density was integrated into the patella, and cartilage of 3 mm thickness was modeled for the patellofemoral joint. According to the survey's results, two different types of patellar bone tunnels (bone socket and transpatellar bone tunnel) were simulated. The risk of patellar fracture was evaluated based on the fracture risk volume (FRV) obtained from the FEA.
Finite element analysis revealed that subchondral bone socket tunnel placement is associated with the lowest FRV but increased with an anterior offset (1-5 mm). Transpatellar bone tunnels violating the lateral or anterior cortex showed a higher FRV compared to bone socket, with the highest values observed when the anterior cortex was penetrated.
Violation of the anterior or lateral patellar cortex using transpatellar bone tunnels increased FRV compared to a subchondral patellar bone socket tunnel. In MPFL reconstruction, subchondral patellar bone socket tunnels should be considered for patellar graft fixation to avoid the risk of postoperative patellar fracture.
Survey; Descriptive laboratory study/Level V.
（1）确定国际髌股研究小组（IPSG）成员在重建内侧髌股韧带（MPFL）时所采用的髌骨钻孔技术；（2）基于有限元分析（FEA）模型评估不同髌骨骨隧道位置发生髌骨骨折的风险。
在研究的第一部分，对IPSG成员进行了关于当前MPFL重建技术的在线调查。在研究的第二部分，使用计算机断层扫描创建了一个健康膝关节的三维FEA模型。将患者特定的骨密度整合到髌骨中，并为髌股关节模拟了3毫米厚的软骨。根据调查结果，模拟了两种不同类型的髌骨骨隧道（骨槽和经髌骨骨隧道）。基于从FEA获得的骨折风险体积（FRV）评估髌骨骨折的风险。
有限元分析显示，软骨下骨槽隧道放置与最低的FRV相关，但随着前偏移（1 - 5毫米）而增加。与骨槽相比，侵犯外侧或前皮质的经髌骨骨隧道显示出更高的FRV，在前皮质被穿透时观察到最高值。
与软骨下髌骨骨槽隧道相比，使用经髌骨骨隧道侵犯髌骨前皮质或外侧皮质会增加FRV。在MPFL重建中，应考虑使用软骨下髌骨骨槽隧道进行髌骨移植物固定，以避免术后髌骨骨折的风险。
调查；描述性实验室研究/Ⅴ级。
