Anterior and distal tunnel orientation for anatomic reconstruction of the medial patellofemoral ligament is safer in patients with open growth plates

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dc.contributor.authorIrarrazaval, Sebastian
dc.contributor.authorBesa, Pablo
dc.contributor.authorFernandez, Francisco
dc.contributor.authorFernandez, Tomas
dc.contributor.authorTuca, Maria
dc.contributor.authorLira, Maria J.
dc.contributor.authorOrrego, Mario
dc.date.accessioned2024-01-10T13:09:59Z
dc.date.available2024-01-10T13:09:59Z
dc.date.issued2020
dc.description.abstractPurpose In patients with open growth plates, the direction of tunneling that avoids distal femoral physis (DFP) damage in anatomic reconstructions of the medial patellofemoral ligament (MPFL) has been a topic of discussion. The objective of this study was to determine the ideal orientation for anatomic reconstructions of MPFL tunneling that minimized DFP damage while avoiding breaching the intercondylar notch. Methods Eighty magnetic resonance images of patients aged 10 through 17 were obtained, randomly sampled from the institutional database. A de novo software was developed to obtain 3D models of the distal femur and DFP. In each model, the anatomical insertion point of the MPFL was determined as defined by Stephen. A 20-mm-depth drilling was simulated, starting from the insertion point at every possible angle within a 90 degrees cone using 5-, 6- and 7-mm drills. Physeal damage for each pair of angles and each drill size was determined. Damage was expressed as a percentage of total physis volume. Statistical analysis was conducted using Student'sttest and one-way ANOVA. Results Maximum physeal damage (5.35% [4.47-6.24]) was obtained with the 7-mm drill when drilling 3 degrees cephalic and 15 degrees posterior from insertion without differences between sexes (n.s.). Minimal physeal damage (0.22% [0.07-0.37]) was obtained using the 5-mm drill aimed 45 degrees distal and 0 degrees anteroposterior, not affected by sex (n.s.). Considering intra-articular drilling avoidance, the safest zone was obtained when aiming 30 degrees-40 degrees distal and 5 degrees-35 degrees anterior, regardless of sex. Conclusion Ideal femoral tunnel orientation, avoiding physeal damage and breaching of the intercondylar notch, was obtained when aiming 30 degrees-40 degrees distal and 5 degrees-35 degrees anterior, regardless of sex. This area is a safe zone that allows anatomic MPFL reconstruction of patients with an open physis.
dc.fechaingreso.objetodigital2024-03-21
dc.format.extent8 páginas
dc.fuente.origenWOS
dc.identifier.doi10.1007/s00167-020-06229-5
dc.identifier.eissn1433-7347
dc.identifier.issn0942-2056
dc.identifier.pubmedidMEDLINE:32809118
dc.identifier.urihttps://doi.org/10.1007/s00167-020-06229-5
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/77737
dc.identifier.wosidWOS:000561824800005
dc.information.autorucFacultad de Medicina; Lira Salas, Maria Jesus; S/I; 195663
dc.language.isoen
dc.nota.accesocontenido parcial
dc.publisherSPRINGER
dc.revistaKNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY
dc.rightsacceso restringido
dc.subjectPediatric patellar instability
dc.subjectMPFL reconstruction
dc.subjectGrowth plate
dc.subjectKnee anatomy
dc.subjectFemoral tunnel positioning
dc.subjectFEMORAL EPIPHYSIS
dc.subjectCHILDREN
dc.subjectINSTABILITY
dc.subjectDISLOCATION
dc.subjectPATELLA
dc.subjectKNEE
dc.subjectTRAUMA
dc.subject.ods05 Gender Equality
dc.subject.odspa05 Igualdad de género
dc.titleAnterior and distal tunnel orientation for anatomic reconstruction of the medial patellofemoral ligament is safer in patients with open growth plates
dc.typeartículo
sipa.codpersvinculados195663
sipa.indexWOS
sipa.indexPubmed
sipa.trazabilidadCarga SIPA;09-01-2024
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