Surgical and Radiological Anatomy of the Medial Patellofemoral Ligament: A Magnetic Resonance Imaging and Cadaveric Study
Vasileios RaoulisApostolos FyllosMichail E. KlontzasDimitrios ChytasVasileios MitrousiasKonstantinos BaniosThomas G. MarisApostolos H. KarantanasAristeidis Zibis
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The purpose of this study was to compare the measurement of several anatomical features of the medial patellofemoral ligament (MPFL) between magnetic resonance imaging (MRI) and by direct fashion during dissection. We hypothesized that the measurements between these two techniques would agree. MRI of 30 fresh-frozen cadaveric knees was followed by dissection. MPFL patella and femoral attachment were evaluated; their shape, length, and width were measured; and measurements were compared. MRI was deemed unreliable for the determination of several of the aforementioned anatomical features. Important findings include: (a) observations on MPFL attachment at medial patella side and attachment to quadriceps were identical between dissection and MRI; (b) average width at patella insertion was significantly different between the two methods (p = 0.002); and (c) an attachment to the quadriceps tendon was present in 20/30 specimens and d. detailed measurements of a thin, non-linear, and three-dimensional structure, such as the MPFL, cannot be performed on MRI, due to technical difficulties. This anatomical radiological study highlights the shape, anatomical measurements (length and width), and attachment of the MPFL using a relatively large cadaveric sample and suggests that MRI is not reliable for detailed imaging of its three-dimensional anatomy.Keywords:
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Human cadavers currently represent the gold standard for spine biomechanical testing, but limitations such as costs, storage, handling, and high interspecimen variance motivate the development of alternatives. A commercially available synthetic surrogate for the human spine, the Sawbones spine model (SBSM), has been developed. The equivalence of SBSM to a human cadaver in terms of biomechanical behavior has not been fully assessed. The objective of this study is to compare the biomechanics of a lumbar tract of SBSM to that of a cadaver under physiologically relevant mechanical loads. An L3-S1 SBSM and 39 comparable human cadaver lumbar spine tracts were used. Each sample was loaded in pure flexion-extension or torsion. Gravity and follower loads were also included. The movement of each vertebral body was tracked via motion capture. The range of motion (ROM) of each spine segment was recorded, as well as the overall stiffness of each L3-S1 sample. The ROM of SBSM L3-L4 was larger than that found in cadavers in flexion-extension and torsion. For the other spine levels, the ROMs of SBSM were within one standard deviation from the mean values measured in cadavers. The values of structural stiffness for L3-S1 of SBSM were comparable to those of cadaveric specimens for both flexion and torsion. In extension, SBSM was more compliant than cadavers. In conclusion, most of the biomechanical properties of an L3-S1 SBSM model were comparable to those of human cadaveric specimens, supporting the use of this synthetic surrogate for testing applications.
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Teraoka, Satoshi1,2; Nomoto, Kikuo2,3; Mito, Michio2; Yoshinaga, Kaoru2; Kurikawa, Kiyoshi2,4; Igata, Akihiro2; Sonoda, Takao2; Fujimi, Satoru2 Author Information
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This study aims to provide biomechanical data on the effect of patella height in the setting of medial patellofemoral ligament (MPFL) reconstruction using finite element analysis. The study will also examine patellofemoral joint biomechanics using variable femoral insertion sites for MPFL reconstruction.A previously validated finite element knee model was modified to study patella alta and baja by translating the patella a given distance to achieve each patella height ratio. Additionally, the models were modified to study various femoral insertion sites of the MPFL (anatomic, anterior, proximal, and distal) for each patella height model, resulting in 32 unique scenarios available for investigation.In the setting of patella alta, the patellofemoral contact area decreased, resulting in a subsequent increase in maximum patellofemoral contact pressures as compared to the scenarios with normal patellar height. Additionally, patella alta resulted in decreased lateral restraining forces in the native knee scenario as well as following MPFL reconstruction. Changing femoral insertion sites had a variable effect on patellofemoral contact pressures; however, distal and anterior femoral tunnel malpositioning in the setting of patella alta resulted in grossly elevated maximum patellofemoral contact pressures as compared to other scenarios.Patella alta after MPFL reconstruction results in decreased lateral restraining forces and patellofemoral contact area and increased maximum patellofemoral contact pressures. When the femoral MPFL tunnel is malpositioned anteriorly or distally on the femur, the maximum patellofemoral contact pressures increase with severity of patella alta.When evaluating patients with patellofemoral instability, it is important to recognize patella alta as a potential aggravating factor. Failure to address patella alta in the setting of MPFL femoral tunnel malposition may result in even further increases in patellofemoral contact pressures, making it essential to optimize intraoperative techniques to confirm anatomic MPFL femoral tunnel positioning.
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There is a paucity of literature documenting the cadaveric muscle thickness of pronator quadratus. We measured the width and depth of this muscle bilaterally in 15 cadavers. There was a significant difference in thickness between male and female cadavers, but the width was proportional to radius length.
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To verify the articular branch contributions in the human knee, delineate their anatomical variance, and outline the limitations of currently applied procedure protocols for denervation of the knee joint.A detailed anatomical dissection.Cadavers in residence at the Albert Einstein College of Medicine.In total, 24 lower extremity specimens from 14 embalmed cadavers.Human cadaveric dissections were performed on 24 lower extremities from 14 embalmed cadavers.This cadaveric study has demonstrated that the anterior knee receives sensory innervations from SMGN, SLGN, LRN, NVI, NVL, RFN, and IMGN. The courses of SMGN, SLGN, RFN, and IMGN are similar to recent anatomical studies. However, discrepancies exist in their relative anatomy to bony and radiographic landmarks.Genicular denervation using classical anatomical landmarks may not be sufficient to treat the anterior knee joint pain. Our findings illustrate more accurate anatomic landmarks for the three-target paradigm and support additional targets for more complete genicular denervation. This cadaveric study provides robust anatomical findings that can provide a foundation for new anatomical landmarks and targets to improve genicular denervation outcomes.
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