Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction
Introduction: The influence of the MPFL graft in cases of patella instability with dysplastic trochlea is a controversial topic. The effect of the MPFL reconstruction as single therapy is under investigation, especially with severely dysplastic trochlea (Dejour types C and D). The purpose of this st...
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| Format: | Article |
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MDPI AG
2022-12-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/12/12/2049 |
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| author | Andreas Frodl Thomas Lange Markus Siegel Hans Meine Elham Taghizadeh Hagen Schmal Kaywan Izadpanah |
| author_facet | Andreas Frodl Thomas Lange Markus Siegel Hans Meine Elham Taghizadeh Hagen Schmal Kaywan Izadpanah |
| author_sort | Andreas Frodl |
| collection | DOAJ |
| description | Introduction: The influence of the MPFL graft in cases of patella instability with dysplastic trochlea is a controversial topic. The effect of the MPFL reconstruction as single therapy is under investigation, especially with severely dysplastic trochlea (Dejour types C and D). The purpose of this study was to evaluate the impact of trochlear dysplasia on patellar kinematics in patients suffering from low flexion patellar instability under weight-bearing conditions after isolated MPFL reconstruction. Material and Methods: Thirteen patients were included in this study, among them were eight patients with mild dysplasia (Dejour type A and B) and five patients with severe dysplasia (Dejour type C and D). By performing a knee MRI with in situ loading, patella kinematics and the patellofemoral cartilage contact area could be measured under the activation of the quadriceps musculature in knee flexion angles of 0°, 15° and 30°. To mitigate MRI motion artefacts, prospective motion correction based on optical tracking was applied. Bone and cartilage segmentation were performed semi-automatically for further data analysis. Cartilage contact area (CCA) and patella tilt were the main outcome measures for this study. Pre- and post-surgery measures were compared for each group. Results: Data visualized a trending lower patella tilt after MPFL graft installation in both groups and flexion angles of the knee. There were no significant changes in patella tilt at 0° (unloaded pre-surgery: 22.6 ± 15.2; post-surgery: 17.7 ± 14.3; <i>p</i> = 0.110) and unloaded 15° flexion (pre-surgery: 18.9 ± 12.7; post-surgery: 12.2 ± 13.0; <i>p</i> = 0.052) of the knee in patients with mild dysplasia, whereas in patients with severe dysplasia of the trochlea the results happened not to be significant in the same angles with loading of 5 kg (0° flexion pre-surgery: 34.4 ± 12.1; post-surgery: 31.2 ± 16.1; <i>p</i> = 0.5; 15° flexion pre-surgery: 33.3 ± 6.1; post-surgery: 23.4 ± 8.6; <i>p</i> = 0.068). CCA increased in every flexion angle and group, but significant increase was seen only between 0°–15° (unloaded and loaded) in mild dysplasia of the trochlea, where significant increase in Dejour type C and D group was seen with unloaded full extension of the knee (0° flexion) and 30° flexion (unloaded and loaded). Conclusion: This study proves a significant effect of the MPFL graft to cartilage contact area, as well as an improvement of the patella tilt in patients with mild dysplasia of the trochlea. Thus, the MPFL can be used as a single treatment for patient with Dejour type A and B dysplasia. However, in patients with severe dysplasia the MPFL graft alone does not significantly increase CCA. |
| first_indexed | 2024-03-09T16:12:57Z |
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| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T16:12:57Z |
| publishDate | 2022-12-01 |
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| spelling | doaj.art-7b22e1d58c114bdaba97feafcf8ad34e2023-11-24T16:02:45ZengMDPI AGJournal of Personalized Medicine2075-44262022-12-011212204910.3390/jpm12122049Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL ReconstructionAndreas Frodl0Thomas Lange1Markus Siegel2Hans Meine3Elham Taghizadeh4Hagen Schmal5Kaywan Izadpanah6Department of Orthopedics and Traumatology, Freiburg University Hospital, 79106 Freiburg, GermanyDepartment of Radiology, Medical Physics, Freiburg University Hospital, 79106 Freiburg, GermanyDepartment of Orthopedics and Traumatology, Freiburg University Hospital, 79106 Freiburg, GermanyFraunhofer Institute for Digital Medicine, 28359 Freiburg, GermanyFraunhofer Institute for Digital Medicine, 28359 Freiburg, GermanyDepartment of Orthopedic Surgery, University Hospital Odense, Sdr. Boulevard 29, 5000 Odense, DenmarkDepartment of Orthopedics and Traumatology, Freiburg University Hospital, 79106 Freiburg, GermanyIntroduction: The influence of the MPFL graft in cases of patella instability with dysplastic trochlea is a controversial topic. The effect of the MPFL reconstruction as single therapy is under investigation, especially with severely dysplastic trochlea (Dejour types C and D). The purpose of this study was to evaluate the impact of trochlear dysplasia on patellar kinematics in patients suffering from low flexion patellar instability under weight-bearing conditions after isolated MPFL reconstruction. Material and Methods: Thirteen patients were included in this study, among them were eight patients with mild dysplasia (Dejour type A and B) and five patients with severe dysplasia (Dejour type C and D). By performing a knee MRI with in situ loading, patella kinematics and the patellofemoral cartilage contact area could be measured under the activation of the quadriceps musculature in knee flexion angles of 0°, 15° and 30°. To mitigate MRI motion artefacts, prospective motion correction based on optical tracking was applied. Bone and cartilage segmentation were performed semi-automatically for further data analysis. Cartilage contact area (CCA) and patella tilt were the main outcome measures for this study. Pre- and post-surgery measures were compared for each group. Results: Data visualized a trending lower patella tilt after MPFL graft installation in both groups and flexion angles of the knee. There were no significant changes in patella tilt at 0° (unloaded pre-surgery: 22.6 ± 15.2; post-surgery: 17.7 ± 14.3; <i>p</i> = 0.110) and unloaded 15° flexion (pre-surgery: 18.9 ± 12.7; post-surgery: 12.2 ± 13.0; <i>p</i> = 0.052) of the knee in patients with mild dysplasia, whereas in patients with severe dysplasia of the trochlea the results happened not to be significant in the same angles with loading of 5 kg (0° flexion pre-surgery: 34.4 ± 12.1; post-surgery: 31.2 ± 16.1; <i>p</i> = 0.5; 15° flexion pre-surgery: 33.3 ± 6.1; post-surgery: 23.4 ± 8.6; <i>p</i> = 0.068). CCA increased in every flexion angle and group, but significant increase was seen only between 0°–15° (unloaded and loaded) in mild dysplasia of the trochlea, where significant increase in Dejour type C and D group was seen with unloaded full extension of the knee (0° flexion) and 30° flexion (unloaded and loaded). Conclusion: This study proves a significant effect of the MPFL graft to cartilage contact area, as well as an improvement of the patella tilt in patients with mild dysplasia of the trochlea. Thus, the MPFL can be used as a single treatment for patient with Dejour type A and B dysplasia. However, in patients with severe dysplasia the MPFL graft alone does not significantly increase CCA.https://www.mdpi.com/2075-4426/12/12/2049cartilage contact areapatella dynamicstrochlea dysplasia |
| spellingShingle | Andreas Frodl Thomas Lange Markus Siegel Hans Meine Elham Taghizadeh Hagen Schmal Kaywan Izadpanah Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction Journal of Personalized Medicine cartilage contact area patella dynamics trochlea dysplasia |
| title | Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction |
| title_full | Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction |
| title_fullStr | Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction |
| title_full_unstemmed | Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction |
| title_short | Individual Influence of Trochlear Dysplasia on Patellofemoral Kinematics after Isolated MPFL Reconstruction |
| title_sort | individual influence of trochlear dysplasia on patellofemoral kinematics after isolated mpfl reconstruction |
| topic | cartilage contact area patella dynamics trochlea dysplasia |
| url | https://www.mdpi.com/2075-4426/12/12/2049 |
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