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Biomechanical evaluation of medial patello-femoral ligament reconstruction: comparison between a double-bundle
G Placella1, A Speziali2, E Sebastiani3
1Fondazione Policlinico Agostino Gemelli, Istituto di Clinica Ortopedica e Traumatologica, Università Cattolica del Sacro Cuore di Roma, Largo Agostino Gemelli, 1 Policlinico Gemelli di Roma, 00135, Rome, Italy. giacomo.placella@gmail.com.
Background:
Several MPFL reconstructions are commonly performed for recurrent patellar dislocation, but misleading data are currently available in the literature on the ability of the different techniques to re-create a functioning ligament.
Materials And Methods:
In this study, we showed the biomechanical properties of two different procedures for MPFL reconstruction using a natural orientation during uniaxial tensile testing. Eighteen fresh-frozen human knees were randomly assigned to two groups of nine each. In the group A, the reconstruction was performed using a double converging tunnels technique and in the group B was used a single-tunnel technique with semitendinosus autograft. The specimens were loaded in natural orientation using an Instron tensile test machine, and the stiffness and ultimate load were determined.
Results:
The ultimate load was 213 ± 90 and 171 ± 51 N using our double-bundle technique (group A) and the single-bundle technique (group B), respectively. One (11 %) specimen failed at the patellar side due to patellar fracture in the group B. There was no statistical significant difference (p > 0.05) between the two groups in terms of stiffness and ultimate load.
Conclusion:
This study is the first biomechanical evaluation of the MPFL reconstructions in natural orientation. Both the procedures achieved safe fixation of the graft at the femoral attachment; however, the single-bundle technique reported 11 % of failure at the patellar side due to patellar fracture. In addition, the double-bundle technique can better restore the anatomy of the native ligament.
