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Variability in the Attachment of the Medial Patellofemoral Ligament
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ABSTRACTS
patients were available for follow-up (5 male, 24 female) at an average of 38 months post op. Twenty two (22) of the 29 patients were >2 years from surgery, and of these, 86.3% were completely free of instability and none had experienced a complete dislocation during the study period. Twenty six (26) of 28 patients (92.9%) were satisfied with their surgical outcome. Twenty-five (25) of 28 patients in the entire cohort were able to return to the same or higher level of activity postoperatively (88.9%). Two (2) patients required manipulation to restore full motion and one 1 developed a postoperative hemarthrosis. Conclusion: MQTFL is an anatomically valid alternative procedure for medial patella stabilization by surgeons who wish to avoid the risks associated with osseous patella fixation. Variability in the Attachment of the Medial Patellofemoral Ligament SS-24 Thursday, April 23 at 3:00 PM MIHO TANAKA, M.D., PRESENTING AUTHOR KRISTEN BRUZZINI, PH.D. Introduction: The medial patellofemoral ligament (MPFL) is known as the primary static stabilizer of the patella. Recent studies have described separate fibers that extend to the quadriceps tendon, as well as techniques to reconstruct this in the treatment of patellar instability. The purpose of this study was to describe the morphology and variability of the attachment of the MPFL. Methods: Dissection was performed on 33 embalmed cadaveric knees, 22 of which were paired. 5 knees did not have identifiable MPFL fibers. In the remaining 28 knees, the MPFL was identified from the articular side after anterior reflection of the extensor mechanism and removal of Layer 3. The width of the MPFL at its origin and attachment were measured using digital calipers. The percentage of the width of the MPFL attachment to the patella (versus the quadriceps tendon) was calculated. The length of the fibers from the origin to the patella and quadriceps tendon was measured and compared using paired t-test. Results: In 28 knees, the mean width at the origin of the MPFL measured 10.7 +/- 1.8mm. The mean width of the MPFL attachment measured 30.4 +/- 5.5mm. The mean percentage of MPFL fibers that inserted onto the patella showed considerable variability, at 57.3 +/- 19.5% (range 0-100%). The mean length of the fibers from the origin to the patella was 62.6 +/-5.2mm, while the mean length of the fibers to the quadriceps tendon was 69.7+/5.5mm, with a 7.1 mm difference between the two (p<0.001). Conclusion: MPFL fibers show considerable variability in the attachment to the patella and the quadriceps tendon. Further studies are needed to identify the appropriate fixation points for reconstruction during patellar stabilization. Furthermore, the length differences between the fibers with patellar and quadriceps tendon attachments suggest a double-bundled graft may better recreate isometry in the reconstruction of this ligament.
Critical Postoperative Time For Rotator Cuff Healing And Re-Tear Predisposing Risk Factors. Retrogression Curve Type of Diagram On Cuff Integrity Over Time SS-25 Friday, April 24 at 9:45 AM JOHANNES BARTH, M.D., PRESENTING AUTHOR ELIAS FOTIADIS, M.D. RENAUD BARTHELEMY, M.D. MO SAFFARINI, M.ENJ. Introduction: The aim of this study was to evaluate at different period postoperatively tendon integrity by ultrasonographic evaluation (USE). We hypothesize that failures of tendon healing (TH) appears early before 3 months post-operatively. Methods: From January 2007 to January 2009, 298 patients scheduled for full thickness RCR were prospectively enrolled in this study. Clinical outcomes were evaluated with Constant score and the repair integrity of RCR was evaluated with USE at 3, 6, 12, and 24 months and at the latest follow up (FU) period postoperatively. Finally, 216 patients were included. Results: The average last FU was 2.6 years (range 21 to 62 months). Preoperatively, Constant score was an average 56 and postoperatively at last FU was 80. Thirty-two percent of the patients had single tendon tears and their TH rate was 94 %, while 68% had multitendon tears and their TH rate was 82% (p¼0.008 x2 test). Fatty infiltration of the infraspinatus >2 was significantly associated with a lower rate of TH (p¼0.007). At 3 months postoperatively 22 out of 216 patients presented rotator cuff re-tear (10 %). At 6 months 10 patients added still (32 out of 216) and the percentage of re-tear was 4.6%. At 12 and 24 months and the last FU postoperatively there were only one patient with a re-torn rotator cuff. Injections of corticoids pre- and postoperatively seem to have no effect in re-tear appearance (Spearman rho¼-0.076, p¼0.270 and Spearman rho¼0.079, p¼0.251, respectively). On the other hand older patients (>61 years old) had more re-tears than younger patients (p¼0.001). There was no statistical significance difference in re-tears between men and women (p¼0.423). Factors as diabetes, hypertensive, cardiac diseases, smokers had no effect on rate of re-tear (p¼0.825, p¼0.873, p¼0.133, p¼0.825, respectively). Conclusion: Two-third of the re-tears occur before 3 months postoperatively. The hypothesis is confirmed.
Pseudoparalysis Can Reliably be Reversed with an Arthroscopic Rotator Cuff Repair in Patients with Minimal Preoperative Arthritis SS-26 Friday, April 24 at 9:50 AM CHRIS ADAMS, M.D., PRESENTING AUTHOR PATRICK DENARD, M.D. ALEXANDRE LÄDERMANN, M.D. PAUL BRADY, M.D. PABLO NARBONA, M.D. PAOLO ARRIGONI, M.D. STEPHEN BURKHART, M.D.
ABSTRACTS
patients were available for follow-up (5 male, 24 female) at an average of 38 months post op. Twenty two (22) of the 29 patients were >2 years from surgery, and of these, 86.3% were completely free of instability and none had experienced a complete dislocation during the study period. Twenty six (26) of 28 patients (92.9%) were satisfied with their surgical outcome. Twenty-five (25) of 28 patients in the entire cohort were able to return to the same or higher level of activity postoperatively (88.9%). Two (2) patients required manipulation to restore full motion and one 1 developed a postoperative hemarthrosis. Conclusion: MQTFL is an anatomically valid alternative procedure for medial patella stabilization by surgeons who wish to avoid the risks associated with osseous patella fixation. Variability in the Attachment of the Medial Patellofemoral Ligament SS-24 Thursday, April 23 at 3:00 PM MIHO TANAKA, M.D., PRESENTING AUTHOR KRISTEN BRUZZINI, PH.D. Introduction: The medial patellofemoral ligament (MPFL) is known as the primary static stabilizer of the patella. Recent studies have described separate fibers that extend to the quadriceps tendon, as well as techniques to reconstruct this in the treatment of patellar instability. The purpose of this study was to describe the morphology and variability of the attachment of the MPFL. Methods: Dissection was performed on 33 embalmed cadaveric knees, 22 of which were paired. 5 knees did not have identifiable MPFL fibers. In the remaining 28 knees, the MPFL was identified from the articular side after anterior reflection of the extensor mechanism and removal of Layer 3. The width of the MPFL at its origin and attachment were measured using digital calipers. The percentage of the width of the MPFL attachment to the patella (versus the quadriceps tendon) was calculated. The length of the fibers from the origin to the patella and quadriceps tendon was measured and compared using paired t-test. Results: In 28 knees, the mean width at the origin of the MPFL measured 10.7 +/- 1.8mm. The mean width of the MPFL attachment measured 30.4 +/- 5.5mm. The mean percentage of MPFL fibers that inserted onto the patella showed considerable variability, at 57.3 +/- 19.5% (range 0-100%). The mean length of the fibers from the origin to the patella was 62.6 +/-5.2mm, while the mean length of the fibers to the quadriceps tendon was 69.7+/5.5mm, with a 7.1 mm difference between the two (p<0.001). Conclusion: MPFL fibers show considerable variability in the attachment to the patella and the quadriceps tendon. Further studies are needed to identify the appropriate fixation points for reconstruction during patellar stabilization. Furthermore, the length differences between the fibers with patellar and quadriceps tendon attachments suggest a double-bundled graft may better recreate isometry in the reconstruction of this ligament.
Critical Postoperative Time For Rotator Cuff Healing And Re-Tear Predisposing Risk Factors. Retrogression Curve Type of Diagram On Cuff Integrity Over Time SS-25 Friday, April 24 at 9:45 AM JOHANNES BARTH, M.D., PRESENTING AUTHOR ELIAS FOTIADIS, M.D. RENAUD BARTHELEMY, M.D. MO SAFFARINI, M.ENJ. Introduction: The aim of this study was to evaluate at different period postoperatively tendon integrity by ultrasonographic evaluation (USE). We hypothesize that failures of tendon healing (TH) appears early before 3 months post-operatively. Methods: From January 2007 to January 2009, 298 patients scheduled for full thickness RCR were prospectively enrolled in this study. Clinical outcomes were evaluated with Constant score and the repair integrity of RCR was evaluated with USE at 3, 6, 12, and 24 months and at the latest follow up (FU) period postoperatively. Finally, 216 patients were included. Results: The average last FU was 2.6 years (range 21 to 62 months). Preoperatively, Constant score was an average 56 and postoperatively at last FU was 80. Thirty-two percent of the patients had single tendon tears and their TH rate was 94 %, while 68% had multitendon tears and their TH rate was 82% (p¼0.008 x2 test). Fatty infiltration of the infraspinatus >2 was significantly associated with a lower rate of TH (p¼0.007). At 3 months postoperatively 22 out of 216 patients presented rotator cuff re-tear (10 %). At 6 months 10 patients added still (32 out of 216) and the percentage of re-tear was 4.6%. At 12 and 24 months and the last FU postoperatively there were only one patient with a re-torn rotator cuff. Injections of corticoids pre- and postoperatively seem to have no effect in re-tear appearance (Spearman rho¼-0.076, p¼0.270 and Spearman rho¼0.079, p¼0.251, respectively). On the other hand older patients (>61 years old) had more re-tears than younger patients (p¼0.001). There was no statistical significance difference in re-tears between men and women (p¼0.423). Factors as diabetes, hypertensive, cardiac diseases, smokers had no effect on rate of re-tear (p¼0.825, p¼0.873, p¼0.133, p¼0.825, respectively). Conclusion: Two-third of the re-tears occur before 3 months postoperatively. The hypothesis is confirmed.
Pseudoparalysis Can Reliably be Reversed with an Arthroscopic Rotator Cuff Repair in Patients with Minimal Preoperative Arthritis SS-26 Friday, April 24 at 9:50 AM CHRIS ADAMS, M.D., PRESENTING AUTHOR PATRICK DENARD, M.D. ALEXANDRE LÄDERMANN, M.D. PAUL BRADY, M.D. PABLO NARBONA, M.D. PAOLO ARRIGONI, M.D. STEPHEN BURKHART, M.D.