Effect of Lateral Retinacular Release on Medial Patellofemoral Ligament Reconstruction.
Effect of Lateral Retinacular Release on Medial Patellofemoral Ligament Reconstruction.
- 2022
Background: When performing a medial patellofemoral ligament (MPFL) reconstruction, surgeons may place the MPFL graft under higher than anatomic tension to minimize the chance of recurrent instability. Clinical Relevance: LRR after an MPFL reconstruction in which the MPFL graft has been OT may help reduce patellofemoral contact pressures at the time of surgery. Copyright © The Author(s) 2022. Conclusion: LRR led to a statistically significant decrease in pressure across the patellofemoral joint in knees that demonstrated increased contact pressures after an OT MPFL graft. Methods: Mean and peak pressure across the patellofemoral joint at 30degree, 45degree, and 60degree of flexion was assessed in 14 cadaveric knee specimens with intact MPFL, transected MPFL, reconstructed MPFL with graft OT, and OT MPFL with LRR. The Wilcoxon signed rank test was used to determine differences across states, with W and C values calculated when possible. Purpose: To investigate whether a lateral retinacular release (LRR) significantly decreases patellofemoral contact pressures after an overtensioned (OT) MPFL reconstruction. Results: Mean pressure decreased significantly after MPFL transection compared with intact at 30degree (456.9 +/- 116.8 vs 410.9 +/- 109.4 N, P = .006, W < 7) and 45degree (404.9 +/- 91.7 vs 369.4 +/- 85.3 N, P = .005, W < 5) and increased significantly from intact to OT graft at 30degree (456.9 +/- 116.8 vs 563.0 +/- 11.2 N, P = .003, W < 7), 45degree (404.9 +/- 91.7 vs 481.4 +/- 14.8 N, P = .005, W < 5), and 60degree (272.9 +/- 139.0 vs 367.0 +/- 53.7 N, P = .007, W < 3). Peak pressure increased significantly between intact and OT graft at 30degree (1364.0 +/- 478.2 vs 2094.4 +/- 619.8 N, P = .002, W < 9), 45degree (1224.7 +/- 491.5 vs 1676.7 +/- 779.1 N, P = .005, W < 5), and 60degree (1117.7 +/- 566.8 vs 1604.2 +/- 772.9 N, W < 3). In knees with significantly increased mean pressure after overtensioning, mean pressure increased by 23.3% (11/14 knees) at 30degree, 18.3% (10/14 knees) at 45degree, and 35.0% (10/14 knees) at 60degree. Peak pressure increased significantly by 35.3% (30degree), 25.2% (45degree), and 29.3% (60degree). A significant decrease in mean pressure, toward but not to baseline, was observed between the OT and LRR states at 30degree (563.0 +/- 11.2 vs 501.5 +/- 9.3 N, W < 7) and 60degree (367.0 +/- 53.7 vs 302.0 +/- 13.8 N, W < 5) and a decrease in peak pressure at 30degree (2094.4 +/- 619.8 vs 1886.5 +/- 655.3 N; W < 9). Study Design: Controlled laboratory study.
English
2325-9671
10.1177_23259671221076877 [pii] 10.1177/23259671221076877 [doi] PMC8848066 [pmc]
Curtis National Hand Center
MedStar Union Memorial Hospital
Foot and Ankle Surgery Fellowship
Orthopaedic Surgery
Orthopaedic Surgery Residency
Journal Article
Background: When performing a medial patellofemoral ligament (MPFL) reconstruction, surgeons may place the MPFL graft under higher than anatomic tension to minimize the chance of recurrent instability. Clinical Relevance: LRR after an MPFL reconstruction in which the MPFL graft has been OT may help reduce patellofemoral contact pressures at the time of surgery. Copyright © The Author(s) 2022. Conclusion: LRR led to a statistically significant decrease in pressure across the patellofemoral joint in knees that demonstrated increased contact pressures after an OT MPFL graft. Methods: Mean and peak pressure across the patellofemoral joint at 30degree, 45degree, and 60degree of flexion was assessed in 14 cadaveric knee specimens with intact MPFL, transected MPFL, reconstructed MPFL with graft OT, and OT MPFL with LRR. The Wilcoxon signed rank test was used to determine differences across states, with W and C values calculated when possible. Purpose: To investigate whether a lateral retinacular release (LRR) significantly decreases patellofemoral contact pressures after an overtensioned (OT) MPFL reconstruction. Results: Mean pressure decreased significantly after MPFL transection compared with intact at 30degree (456.9 +/- 116.8 vs 410.9 +/- 109.4 N, P = .006, W < 7) and 45degree (404.9 +/- 91.7 vs 369.4 +/- 85.3 N, P = .005, W < 5) and increased significantly from intact to OT graft at 30degree (456.9 +/- 116.8 vs 563.0 +/- 11.2 N, P = .003, W < 7), 45degree (404.9 +/- 91.7 vs 481.4 +/- 14.8 N, P = .005, W < 5), and 60degree (272.9 +/- 139.0 vs 367.0 +/- 53.7 N, P = .007, W < 3). Peak pressure increased significantly between intact and OT graft at 30degree (1364.0 +/- 478.2 vs 2094.4 +/- 619.8 N, P = .002, W < 9), 45degree (1224.7 +/- 491.5 vs 1676.7 +/- 779.1 N, P = .005, W < 5), and 60degree (1117.7 +/- 566.8 vs 1604.2 +/- 772.9 N, W < 3). In knees with significantly increased mean pressure after overtensioning, mean pressure increased by 23.3% (11/14 knees) at 30degree, 18.3% (10/14 knees) at 45degree, and 35.0% (10/14 knees) at 60degree. Peak pressure increased significantly by 35.3% (30degree), 25.2% (45degree), and 29.3% (60degree). A significant decrease in mean pressure, toward but not to baseline, was observed between the OT and LRR states at 30degree (563.0 +/- 11.2 vs 501.5 +/- 9.3 N, W < 7) and 60degree (367.0 +/- 53.7 vs 302.0 +/- 13.8 N, W < 5) and a decrease in peak pressure at 30degree (2094.4 +/- 619.8 vs 1886.5 +/- 655.3 N; W < 9). Study Design: Controlled laboratory study.
English
2325-9671
10.1177_23259671221076877 [pii] 10.1177/23259671221076877 [doi] PMC8848066 [pmc]
Curtis National Hand Center
MedStar Union Memorial Hospital
Foot and Ankle Surgery Fellowship
Orthopaedic Surgery
Orthopaedic Surgery Residency
Journal Article