Felix Zimmermann1, Mareike Schonhoff2, Sebastian Jäger2, Danko Dan Milinkovic3, Jochen Franke1, Paul Alfred Grützner1, Peter Balcarek4,5, Sven Vetter6. 1. Berufsgenossenschaftliche Unfallklinik Ludwigshafen, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Germany. 2. Labor für biomechanik und Implantatforschung, Universitätsklinikum Heidelberg, Heidelberg, Germany. 3. Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus Mitte, Berlin, Germany. 4. Arcus Sportklinik, Pforzheim, Germany. 5. Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medicine Göttingen, Göttingen, Germany. 6. Berufsgenossenschaftliche Unfallklinik Ludwigshafen, BG Klinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen am Rhein, Germany. sven.vetter@bgu-ludwigshafen.de.
Abstract
PURPOSE: Reconstruction of the medial patellofemoral ligament (MPFL-R) with nonresorbable suture tape (FiberTape®, FT) is becoming popular. Patella-side fixation of the FT can be performed with suture anchors or via soft-tissue fixation. The aim of this study was to investigate whether patella-side soft-tissue fixation can achieve equivalent primary stability compared to suture-anchor fixation. METHODS: In ten human, fresh-frozen knee joint specimens (m/f 6/4; age 74 ± 9 a), the MPFL was identified and dissected near the femoral insertion site. In five knee joints, the MPFL-R using FT was performed with soft-tissue fixation at the patella (study group; SG), and in five knee joints, the FT was fixed via suture anchors (control group, CG). All reconstructions were evaluated until load to failure of the patella-side fixation with a displacement rate of 200 mm/min. RESULTS: The mean maximum load to failure in the SG was 395.3 ± 57.9 N. All reconstructions failed by complete tearing off the medial patellar retinaculum from its medial patellar margin, but fixation of the FT remained stable. In the CG, the mean maximum load to failure was 239.4 ± 54.5 N and was significantly different compared to the SG (p = 0.04). All reconstructions failed via pullout of the suture anchors. Stiffness and elongation did not differ between the groups, and no failure of the FT was observed in any of the specimens. CONCLUSION: Primary stability of soft-tissue MPFL-R using FT was superior to suture-anchor fixation. Both fixation techniques provided sufficient primary stability, superior to previously reported native MPFL tensile strengths. MPFL-R with FT could be a possible alternative procedure for MPFL-R, eliminating potential complications due to autologous tendon graft harvesting.
PURPOSE: Reconstruction of the medial patellofemoral ligament (MPFL-R) with nonresorbable suture tape (FiberTape®, FT) is becoming popular. Patella-side fixation of the FT can be performed with suture anchors or via soft-tissue fixation. The aim of this study was to investigate whether patella-side soft-tissue fixation can achieve equivalent primary stability compared to suture-anchor fixation. METHODS: In ten human, fresh-frozen knee joint specimens (m/f 6/4; age 74 ± 9 a), the MPFL was identified and dissected near the femoral insertion site. In five knee joints, the MPFL-R using FT was performed with soft-tissue fixation at the patella (study group; SG), and in five knee joints, the FT was fixed via suture anchors (control group, CG). All reconstructions were evaluated until load to failure of the patella-side fixation with a displacement rate of 200 mm/min. RESULTS: The mean maximum load to failure in the SG was 395.3 ± 57.9 N. All reconstructions failed by complete tearing off the medial patellar retinaculum from its medial patellar margin, but fixation of the FT remained stable. In the CG, the mean maximum load to failure was 239.4 ± 54.5 N and was significantly different compared to the SG (p = 0.04). All reconstructions failed via pullout of the suture anchors. Stiffness and elongation did not differ between the groups, and no failure of the FT was observed in any of the specimens. CONCLUSION: Primary stability of soft-tissue MPFL-R using FT was superior to suture-anchor fixation. Both fixation techniques provided sufficient primary stability, superior to previously reported native MPFL tensile strengths. MPFL-R with FT could be a possible alternative procedure for MPFL-R, eliminating potential complications due to autologous tendon graft harvesting.
Authors: Peter Balcarek; Jan Ammon; Stephan Frosch; Tim A Walde; Jan P Schüttrumpf; Keno G Ferlemann; Helmut Lill; Klaus M Stürmer; Karl-Heinz Frosch Journal: Arthroscopy Date: 2010-03-03 Impact factor: 4.772
Authors: Markus Gesslein; Carolin Merkl; Hermann Josef Bail; Volker Krutsch; Roland Biber; Philipp Schuster Journal: Cartilage Date: 2019-11-13 Impact factor: 3.117