Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Vicente Sanchis-Alfonso; Gerard Ginovart; Diego Alastruey-López; Erik Montesinos-Berry; Joan Carles Monllau; Angel Alberich-Bayarri; María Angeles Pérez

doi:10.3390/jcm8122093

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

J Clin Med. 2019 Dec 1;8(12):2093. doi: 10.3390/jcm8122093.

Authors

Vicente Sanchis-Alfonso¹, Gerard Ginovart², Diego Alastruey-López³, Erik Montesinos-Berry⁴, Joan Carles Monllau⁵, Angel Alberich-Bayarri⁶, María Angeles Pérez³

Affiliations

¹ Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, Carrer de Sant Clement 12, 46015 Valencia, Spain.
² Department of Orthopaedic Surgery, Hospital Terres de l`Ebre, 43500 Tortosa, Spain.
³ Multiscale in Mechanical and Biological Engineering (M2BE), Aragón Institute of Engineering Research (I3A), Department of Mechanical Engineering, University of Zaragoza, 50018 Zaragoza, Spain.
⁴ Orthopaedic Surgeon, Agoriaz Orthopaedic Center, Riaz and Clinique CIC, 1832 Montreux, Switzerland.
⁵ Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain.
⁶ Quantitative Imaging Biomarkers in Medicine(QUIBIM) SL, Quantitative Imaging Biomarkers in Medicine, GIBI230, Biomedical Imaging Research Group, La Fe Health Research Institute, 46026 Valencia, Spain.

Abstract

Objectives: To evaluate the effect of various medial patellofemoral ligament (MPFL) fixation techniques on patellar pressure compared with the native knee.

Methods: A finite element model of the patellofemoral joint consisting of approximately 30,700 nodes and 22,200 elements was created from computed tomography scans of 24 knees with chronic lateral patellar instability. Patellar contact pressures and maximum MPFL graft stress at five positions of flexion (0°, 30°, 60°, 90°, and 120°) were analyzed in three types of MPFL reconstruction (MPFLr): (1) static/anatomic, (2) dynamic, using the adductor magnus tendon (AMT) as the femoral fixation, and (3) dynamic, using the quadriceps tendon as the attachment (medial quadriceps tendon-femoral ligament (MQTFL) reconstruction).

Results: In the static/anatomic technique, the patellar contact pressures at 0° and 30° were greater than in the native knee. As in a native knee, the contact pressures at 60°, 90°, and 120° were very low. The maximum MPFL graft stress at 0° and 30° was greater than in a native knee. However, the MPFL graft was loose at 60°, 90°, and 120°, meaning it had no tension. In the dynamic MPFLr using the AMT as a pulley, the patellar contact pressures were like those of a native knee throughout the entire range of motion. However, the maximum stress of the MPFL graft at 0° was less than that of a native ligament. Yet, the maximum MPFL graft stress was greater at 30° than in a native ligament. After 30° of flexion, the MPFL graft loosened, similarly to a native knee. In the dynamic MQTFL reconstruction, the maximum patellar contact pressure was slightly greater than in a normal knee. The maximum stress of the MPFL graft was much greater at 0° and 30° than that of a native MPFL. After 30° of flexion, the MQPFL graft loosened just as in the native knee.

Conclusions: The patellar contact pressures after the dynamic MPFLr were like those of the native knee, whereas a static reconstruction resulted in greater pressures, potentially increasing the risk of patellofemoral osteoarthritis in the long term. Therefore, the dynamic MPFLr might be a safer option than a static reconstruction from a biomechanical perspective.

Keywords: Finite element model; MPFL reconstruction; Patellar cartilage degeneration after MPFL reconstruction; Patellar contact pressure.