Radiographic Location Does Not Ensure a Precise Anatomic Location of the Femoral Fixation Site in Medial Patellofemoral Ligament Reconstruction
Sanchis-Alfonso, Vicente (Hospital Arnau de Vilanova (València))
Ramírez-Fuentes, Cristina (Instituto de Investigación Sanitaria La Fe (València))
Montesinos-Berry, Erik (Universitat Autònoma de Barcelona)
Elía, Isabel (Instituto de Investigación Sanitaria La Fe (València))
Martí-Bonmatí, Luis (Instituto de Investigación Sanitaria La Fe (València))

Data:	2017
Resum:	A frequently used method to determine the anatomic femoral fixation point in the operating room during medial patellofemoral ligament (MPFL) reconstruction is the radiographic method. However, the ability of this radiological method to establish an anatomic femoral attachment point might not be as accurate as expected. (1) To evaluate the accuracy of the radiological method to locate the anatomic femoral fixation point in MPFL reconstruction surgery and (2) to determine the factors influencing the predictability of this method to obtain this objective. Cohort study (diagnosis); Level of evidence, 2. A total of 100 consecutive 3-dimensional computed tomography (3D CT) knee examinations were performed at 0° of extension in 87 patients treated for chronic lateral patellar instability. For each knee, 2 virtual 7 mm-diameter femoral tunnels were created: 1 using the adductor tubercle as a landmark (anatomic tunnel) and the other according to the radiological method described by Schöttle et al (radiographic tunnel). We measured the percentage of overlap between both tunnels. Moreover, of the 100 included knees, 10 were randomly selected for a variability study. Considering an overlap area greater than 50% as reasonable, the radiographic method achieved this in only 38 of the 100 knees. Intrarater and interrater reliability were excellent. There was a trend for female patients with severe trochlear dysplasia to have less overlap. This model accounted for 64. 2% of the initial variability in the data. An exact anatomic femoral tunnel placement could not be achieved with the radiographic method. Radiography provided only an approximation and should not be the sole basis for the femoral attachment location. Moreover, in female patients with severe trochlear dysplasia, the radiographic method was less accurate in determining the anatomic femoral fixation point, although differences were not statistically significant.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Medial patellofemoral ligament ; Femoral attachment ; MPFL anatomic reconstruction ; 3D CT
Publicat a:	Orthopaedic Journal of Sports Medicine, Vol. 5 (november 2017) , ISSN 2325-9671

DOI: 10.1177/2325967117739252
PMID: 29201927

6 p, 234.7 KB

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