Lateral retinacular release in concordance with medial patellofemoral ligament reconstruction in patients with recurrent patellar instability: A computational model |
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| Affiliation: | 1. Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy;2. Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy;3. Engineering, Global Orthopaedics, Sydney, Australia;4. Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;5. Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA;1. Institute of Applied Health Sciences, University of Aberdeen, NHS Grampian, AB24 3FX, United Kingdom;2. University of Groningen, University Medical Centre Groningen, Groningen 9713 GZ, the Netherlands;3. Trauma and Orthopaedics, Dr Gray''s Hospital, Elgin, NHS Grampian, IV30 1SN, United Kingdom;1. Universidade Estadual do Oeste do Paraná, Cascavel, Paraná, Brazil;2. Universidade Brasil, São Paolo, Brazil;1. Mersin University Medical School, Department of Physical and Rehabilitation Medicine, Mersin, Turkey;2. Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey;1. Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, PR China;2. Suzhou Medical College of Soochow University, Suzhou, PR China;3. Department of Orthopedics, Wujiang Fourth People’s Hospital, Wujiang, Suzhou, PR China |
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| Abstract: | BackgroundThe aim of this study was to develop and validate a finite element (FE) model of the patellofemoral joint to analyze the biomechanics of lateral retinacular release after medial patellofemoral ligament (MPFL) reconstruction in patellar malalignment (increased tibial tubercle–trochlear groove distance (TT-TG)). We hypothesized that lateral retinacular release is not appropriate in patellar instability addressed by MPFL reconstruction due to decreased lateral stability and inappropriate adjustment in patellofemoral contact pressures.MethodsA FE in-silico model of the patellofemoral joint was developed and validated. The model was used analyze the effect of lateral retinacular release in association with MPFL reconstruction on patellofemoral contact pressures, contact area, and lateral patellar displacement during knee flexion.ResultsMPFL reconstruction alone results in restoration of patellofemoral contact pressures throughout the entire range of motion (0–90°), mimicking the results from healthy condition. The addition of the lateral retinacular release to the MPFL reconstruction resulted in significant reductions in both patellofemoral contact pressure and contact area. Lateral retinacular release resulted in more lateral patellar displacement during the mid-flexion knee range of motion.ConclusionsCombination of lateral retinacular release with MPFL reconstruction in patients with increased TT-TG is not recommended as MPFL reconstruction alone for first-line management of recurrent patellar instability offers a greater biomechanical advantage and restoration of contact forces to resemble that of the healthy knee. The presented biomechanical data outlines the effect of concomitant MPFL reconstruction and lateral retinacular release to help guide surgical planning for patients with recurrent patellar instability due to malalignment. |
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| Keywords: | Medial patellofemoral ligament Tibial tuberosity–trochlear groove distance Tibial tuberosity transfer Patellar instability Patellar dislocation |
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