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The quadriceps insertion of the medial patellofemoral complex demonstrates the greatest anisometry through flexion

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A comprehensive understanding of the biomechanical properties of the medial patellofemoral complex (MPFC) is necessary when performing an MPFC reconstruction. How components of the MPFC change over the course of flexion can influence the surgeon’s choice of location for graft fixation along the extensor mechanism. The purpose of this study was to (1) determine native MPFC length changes throughout a 90° arc using an anatomically based attachment and using Schöttle’s point, and (2) compare native MPFC length changes with different MPFC attachment sites along the extensor mechanism.

Methods

Eight fresh-frozen (n = 8), cadaveric knees were dissected of all soft tissue structures except the MPFC. The distance between the femoral footprint (identified through anatomical landmarks and Schottle’s point) and the MPFC was calculated at four attachment sites along the extensor mechanism [midpoint of the patella [MP], the center of the osseous footprint of the MPFC (FC), the superomedial corner of the patella at the quadriceps insertion (SM), and the proximal extent of the MPFC along the quadriceps tendon (QT)] at 0°, 20°, 40°, 60°, and 90° of flexion.

Results

Length changes were investigated between the MPFL femoral attachment site and the radiographic surrogate of the MPFL attachment site, Schottle’s Point (SP). Paired t tests at each of the four components showed no differences in length change from 0° to 90° when comparing SP to the anatomic MPFC insertion. MPFL length changes from 0° to 90° were greatest at the QT point (13.9 ± 3.0 mm) and smallest at the MP point (2.7 ± 4.4 mm). The FC and SM points had a length change of 6.6 ± 4.2 and 9.0 ± 3.8, respectively. Finally, when examining how the length of the MPFC components changed through flexion, the greatest differences were seen at QT where all comparisons were significant (p < 0.01) except when comparing 0° vs 20° (n.s.).

Conclusion

The MPFC demonstrates the most significant length changes between 0° and 20° of flexion, while more isometric behavior was seen during 20°–90°. The attachment points along the extensor mechanism demonstrate different length behaviors, where the more proximal components of the MPFC display greater anisometry through the arc of motion. When performing a proximal MPFC reconstruction, surgeons should expect increased length changes compared to reconstructions utilizing distal attachment sites.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Rush University Medical Center, 1611 W. Harrison St., Ste 300, Chicago, IL, 60612, USA

    Hailey P. Huddleston, Kevin J. Campbell, Brett T. Madden, Jorge Chahla, Brian J. Cole & Adam B. Yanke

  2. McGaw Medical Center at Northwestern University, Chicago, IL, 60611, USA

    David R. Christian

  3. OrthoIndy, Greenwood, IN, 46143, USA

    Jack Farr

Authors
  1. Hailey P. Huddleston
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  2. Kevin J. Campbell
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  3. Brett T. Madden
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  4. David R. Christian
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  5. Jorge Chahla
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  6. Jack Farr
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  7. Brian J. Cole
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  8. Adam B. Yanke
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Corresponding author

Correspondence to Adam B. Yanke.

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Conflict of Interest

Dr. Cole is on the editorial or governing board for the American Journal of Orthopedics, American Journal of Sports Medicine, Cartilage, Journal of Shoulder and Elbow Surgery (editor only), and Journal of the American Academy of Orthopaedic Surgeons (editor only). Dr. Cole receives research support from Aesculap/B.Braun, Arthrex, Inc., National Institutes of Health (NIAMS & NICHD), and Regentis. Dr. Cole is on the board or committee member for Arthroscopy Association of North America and International Cartilage Repair Society. Dr. Cole is a paid consultant for Arthrex, Inc. and Regentis. Dr. Cole receives IP royalties from Arthrex, Inc. and Elsevier Publishing. Dr. Cole has stock or stock options in Bandgrip Inc., Ossio, and Regentis. Dr. Cole receives publishing royalties from Operative Techniques in Sports Medicine. Dr. Cole receives financial or material support from Athletico, JRF Ortho, Operative Techniques in Sports Medicine, and Smith & Nephew.

Dr. Farr is on the editorial or governing board for the American Journal of Orthopedics and Cartilage. Dr. Farr receives research support from Active Implants, Arthrex, Inc., Episurf, Fidia, JRF Ortho, Moximed, Organogenesis, Samumed, Vericel, Norvartis, and ZimmerBiomet. Dr. Farr is a paid consultant for Aesculap/B.Braun, Cartiheal, Cook Biotech, Inc., Exactech, Moximed, Organogenesis, Regentis, Samumed, and ZKR Orthopedics, Inc. Dr. Farr receives IP royalties from Arthrex, Inc., Biopoly, LLC, and Organogensis. Dr. Farr has stock or stock options in MedShape, Inc., Ortho Regenerative Tech, Inc. Dr. Farr is a paid presenter or speaker for Arthrex, Inc., Moximed, Organogenesis, and Vericel. Dr. Farr receives publishing royalties and financial or material support from Springer and Thieme Medical Publishers, Inc.

Dr. Yanke receives research support from Arthrex, Inc, Vericel, and Organogenesis. Dr. Yanke is a paid consultant for CONMED Linvatec, JRF Ortho, and Olympus and an unpaid consultant for PatientIQ, Smith & Nephew, and Sparta Biomedical. He has stock or stock options in PatientIQ.

Dr. Chahla is an unpaid consultant for Arthrex, Inc, CONMED Linvatec, and Smith & Nephew.

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There is no funding source.

Ethical approval

This study did not need IRB approval due to the use of cadaveric specimen.

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Huddleston, H.P., Campbell, K.J., Madden, B.T. et al. The quadriceps insertion of the medial patellofemoral complex demonstrates the greatest anisometry through flexion. Knee Surg Sports Traumatol Arthrosc 29, 757–763 (2021). https://doi.org/10.1007/s00167-020-05999-2

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  • DOI: https://doi.org/10.1007/s00167-020-05999-2

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