Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.
BMC Musculoskelet Disord. 2022 Feb 11;23(1):139. doi: 10.1186/s12891-022-05013-5.
Medial patellofemoral ligament (MPFL) injury occurs in the majority of the cases of acute patellar dislocation. The role of concomitant lateral retinaculum release with MPFL reconstruction is not clearly understood. Even though the lateral retinaculum plays a role in both medial and lateral patellofemoral joint stability in MPFL intact knees, studies have shown mixed clinical outcomes following its release during MPFL reconstruction surgery. Better understanding of the biomechanical effects of the release of the lateral retinaculum during MPFL reconstruction is warranted. We hypothesize that performing a lateral release concurrent with MPFL reconstruction will disrupt the patellofemoral joint biomechanics and result in lateral patellar instability.
A previously developed and validated finite element (FE) model of the patellofemoral joint was used to understand the effect of lateral retinaculum release following MPFL reconstruction. Contact pressure (CP), contact area (CA) and lateral patellar displacement were recorded. abstract.
FE modeling and analysis demonstrated that lateral retinacular release following MPFL reconstruction with tibial tuberosity-tibial groove distance (TT-TG) of 12 mm resulted in a 39% decrease in CP, 44% decrease in CA and a 20% increase in lateral patellar displacement when compared to a knee with an intact MPFL. In addition, there was a 45% decrease in CP, 44% decrease in CA and a 21% increase in lateral displacement when compared to a knee that only had an MPFL reconstruction.
This FE-based analysis exhibits that concomitant lateral retinaculum release with MPFL reconstruction results in decreased PF CA, CP and increased lateral patellar displacement with increased knee flexion, which may increase the risk of patellar instability.
在大多数急性髌骨脱位的病例中，都会发生内侧髌股韧带（MPFL）损伤。MPFL 重建时同时松解外侧支持带的作用尚不清楚。尽管外侧支持带在 MPFL 完整的膝关节中对内侧和外侧髌股关节稳定性都有作用，但研究表明，在 MPFL 重建手术中松解外侧支持带后，临床结果存在差异。因此，有必要更好地了解 MPFL 重建过程中松解外侧支持带对生物力学的影响。我们假设，在进行 MPFL 重建的同时进行外侧松解，将破坏髌股关节的生物力学，并导致外侧髌骨不稳定。
使用先前开发和验证的髌股关节有限元（FE）模型来了解 MPFL 重建后外侧支持带松解的影响。记录接触压力（CP）、接触面积（CA）和外侧髌骨位移。
FE 建模和分析表明，与 MPFL 完整的膝关节相比，当 TT-TG（胫骨结节-胫骨沟距离）为 12mm 时，MPFL 重建后松解外侧支持带会导致 CP 降低 39%、CA 降低 44%、外侧髌骨位移增加 20%。此外，与仅进行 MPFL 重建的膝关节相比，CP 降低 45%、CA 降低 44%、外侧髌骨位移增加 21%。
这项基于 FE 的分析表明，MPFL 重建时同时松解外侧支持带会导致 PF CA、CP 减少，膝关节屈曲时外侧髌骨位移增加，这可能会增加髌骨不稳定的风险。
