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Related Experiment Video

Updated: Apr 12, 2026

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
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Fluoroscopic control allows for precise tunnel positioning in MPFL reconstruction.

Vera Jaecker1, Benedikt Brozat1, Marc Banerjee1

  • 1Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|May 11, 2015
PubMed
Summary

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Intraoperative fluoroscopic control reliably guides femoral tunnel placement in medial patellofemoral ligament (MPFL) reconstruction. This method ensures precise, anatomical graft positioning, improving patellofemoral stability and joint biomechanics.

Area of Science:

  • Orthopedic surgery
  • Biomechanics
  • Radiology

Background:

  • Anatomical graft positioning is crucial for medial patellofemoral ligament (MPFL) reconstruction to restore knee biomechanics and stability.
  • Non-anatomical femoral tunnel placement is a common issue in MPFL reconstruction procedures.
  • Accurate tunnel positioning is essential for successful surgical outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of intraoperative fluoroscopic control in achieving precise femoral tunnel positioning during MPFL reconstruction.
  • To determine if fluoroscopy can reduce variability in femoral tunnel placement compared to traditional methods.

Main Methods:

  • Analysis of femoral tunnel positions from 116 MPFL reconstructions using intraoperative fluoroscopic images.
Keywords:
Graft positioningMPFLMedial patellofemoral ligament reconstructionPatellofemoral instabilityPrecisionTunnel positioningVariability

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  • Determination of tunnel positions by two independent observers using Schöttle's radiographic measurement method.
  • Calculation of mean positions, standard deviations, ranges, and interclass correlation coefficients (ICC) to assess variability and reliability.

    • Main Results:

    • 95.7% of femoral tunnel positions were within the defined anatomical insertion area.
    • Mean deviations from the anatomical insertion were minimal (2.34 mm anterior/posterior, 1.7 mm proximal/distal).
    • High interobserver reliability was observed for tunnel position measurements (ICC: 0.979 for depth and height).

    Conclusions:

    • Intraoperative fluoroscopic control is a feasible and effective method for creating reproducible and precise anatomical femoral tunnel positions in MPFL reconstruction.
    • Routine use of intraoperative fluoroscopy is recommended for MPFL reconstruction surgery.
    • Schöttle's method is a reliable tool for both intraoperative control and postoperative analysis of femoral tunnel positioning.