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Is there a place for MPFL reconstruction in a total knee arthroplasty?

Published in N°19 - September / October 2022
Article viewed 72 times

Is there a place for MPFL reconstruction in a total knee arthroplasty?

By Cécile Batailler, Elvire Servien, Sébastien Lustig in category TECHNIQUE
Lyon Croix Rousse University Hospital, 3 Grande rue de la Croix Rousse, 69004 Lyon, France / [email protected]

Patellofemoral instability (PFI) is one of the causes of failure after total knee arthroplasty (TKA). It can be the cause of most patellar complications, including anterior pain, abnormal wear or loosening of the patellar component, possibly even dislocation.

Introduction

Patellofemoral instability (PFI) is one of the causes of failure after total knee arthroplasty (TKA).[1,2] It can be the cause of most patellar complications, including anterior pain, abnormal wear or loosening of the patellar component, possibly even dislocation.[3]

Patellar instability is not entirely due to patellofemoral technical errors, but can also result from balancing errors, especially in the axial plane with wrong rotational alignment of the components. Any surgery will put greater tension on the lateral retinaculum, reduce it on the medial side, or increase the Q angle, which affects patellar balance and results in this instability. The technical causes of PFI can be grouped into four main categories:[4]

  • Component malpositioning, especially in the axial plane (rotation), frontal plane (valgus alignment) or sagittal plane (increase or reduction in anterior space);[5]
  • Unsuitable trochlear component design;[6]
  • Improper or non-existent patellar preparation;[7]
  • Soft-tissue imbalance.[8]

PFI can therefore be prevented by using the correct implant and applying the main accepted principles for knee arthroplasty[4] . Applying these basic rules should result in stable and centred patellar tracking:

  • correct limb alignment, avoiding valgus,[9]
  • neutral or...

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