BIOMECHANICAL ACCESS METHOD FOR ANALYZING ISOMETRICITY IN RECONSTRUCTING THE MEDIAL PATELLOFEMORAL LIGAMENT

David Sadigursky¹, Riccardo Gomes Gobbi², César Augusto Martins Pereira³, José Ricardo Pécora⁴, Gilberto Luis Camanho⁵

Affiliations

¹ MSc from the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
² Attending Physician in the Knee Group, Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
³ Technologist in the Biomechanics Laboratory, Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
⁴ PhD in Sciences and Head of the Knee Group, Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
⁵ Titular Professor and Head of the Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.

PMID: 27047872
PMCID: PMC4799453
DOI: 10.1016/S2255-4971(15)30010-0

BIOMECHANICAL ACCESS METHOD FOR ANALYZING ISOMETRICITY IN RECONSTRUCTING THE MEDIAL PATELLOFEMORAL LIGAMENT

David Sadigursky et al. Rev Bras Ortop. 2015.

. 2015 Nov 4;47(5):598-605.

doi: 10.1016/S2255-4971(15)30010-0. eCollection 2012 Sep-Oct.

Authors

David Sadigursky¹, Riccardo Gomes Gobbi², César Augusto Martins Pereira³, José Ricardo Pécora⁴, Gilberto Luis Camanho⁵

Affiliations

¹ MSc from the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
² Attending Physician in the Knee Group, Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
³ Technologist in the Biomechanics Laboratory, Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
⁴ PhD in Sciences and Head of the Knee Group, Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
⁵ Titular Professor and Head of the Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.

PMID: 27047872
PMCID: PMC4799453
DOI: 10.1016/S2255-4971(15)30010-0

Abstract

Objective: To present a biomechanical device for evaluating medial patellofemoral ligament (MPFL) reconstruction and its isometricity.

Methods: An accessible biomechanical method that allowed application of physiological and non-physiological forces to the knee using a mechanical arm and application of weights and counterweights was developed, so as to enable many different evaluations and have a very accurate measurement system for distances between different structures, for analysis on experiments. This article describes the assembly of this system, and suggests some practical applications. Six cadaver knees were studied. The knees were prepared in a testing machine developed at the Biomechanics Laboratory of IOT-HCFMUSP, which allowed dynamic evaluation of patellar behavior, with quantification of patellar lateralization between 0° and 120°. The differences between the distances found with and without load applied to the patella were grouped according to the graft fixation angle (0°, 30°, 60° or 90°) and knee position (intact, damaged or reconstructed).

Results: There was a tendency for smaller lateral displacement to occur at fixation angles greater than 30 degrees of flexion, especially between the angles of 45° and 60° degrees of flexion, after the reconstruction. For the other angles, there was no statistical significance.

Conclusion: The method developed is a useful tool for studies on the patellofemoral joint and the MPFL, and has a very accurate measurement system for distances between different structures. It can be used in institutions with fewer resources available.

Keywords: Biomechanics; Joint Instability; Knee/surgery; Patellar Ligament.

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Figures

**Figure 1**
Resection of the middle third of the patellar ligament going towards the medial edge of the patella, between the middle and proximal thirds.

**Figure 2**
Schematic representation of the left knee positioned in the mechanical device coupled to the universal mechanical test device. Front and side views of the components of the device.

**Figure 3**
Right knee fixed to the mechanical device, showing the weight coupled to the pulley (right) and the weight used to lateralize the patella (left).

**Figure 4**
Graft fixation system with cannulated screw and load cell. In detail, the Ethibond^® wires tied to the upper beam of the load cell.

**Figure 5**
Triangular templates used in the three-dimensional measurement process.

**Figure 6**
Mediolateral deviation of the patella ± standard error, according to the graft reconstruction angle and the knee flexion angle.

**Figure 7**
Mediolateral deviation of the patella ± standard error, according to the graft reconstruction angle and the knee flexion angle.

See this image and copyright information in PMC

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BIOMECHANICAL ACCESS METHOD FOR ANALYZING ISOMETRICITY IN RECONSTRUCTING THE MEDIAL PATELLOFEMORAL LIGAMENT

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BIOMECHANICAL ACCESS METHOD FOR ANALYZING ISOMETRICITY IN RECONSTRUCTING THE MEDIAL PATELLOFEMORAL LIGAMENT

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Abstract

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