06 Chouteau Bio Mechanics Od the MPFL Copy
Transcript of 06 Chouteau Bio Mechanics Od the MPFL Copy
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MPFL: Biom ec hanic s
Dr Julien Chouteau PHU MD PHD , Pr Bernard Moyen
Department of Orthopaedics, Trauma and Sport Medicine, Lyon-Sud Hospital, Pierre-Bénite,
France
Efort Instructional Course, Lyon March 2011
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MPFL
Medial
PatelloFemoral Ligament
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Superficial Layer:
Medial Retinaculum
LAYERS
ON THE MEDIAL ASPECT
OF THE KNEE
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Second (intermediate) layer:(same as MCL)
Medial
PatelloFemoral ligament
(MPFL)
LAYERS
ON THE MEDIAL ASPECT
OF THE KNEE
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Deepest Layer:
Medial PatelloMeniscal
ligament (MPML)
LAYERS
ON THE MEDIAL ASPECT
OF THE KNEE
MPMLLenght 39.4 ± 3.2mm
Width 9.6 ± 1.2mm
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LAYERS
ON THE MEDIAL ASPECT
OF THE KNEE
Deepest Layer :
MedialPatelloTibial ligament
(MPTL)
MPTLLenght 54.6 ± 8.4mm
Width 21.8 ± 4.4mm
MPFL & MPTL Found in 47%
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MPFL ANATOMY
Philippot, Chouteau and al 2009, 23 cadaveric knees
MPFL Always Observed
Lenght : 57.7 ± 5.8mm
Width
• at the femoral insertion: 12.2 ± 2.6mm
• at the patellar insertion: 24.4 ± 4.8mm
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Jonction between vastus medialis
obliquus (VMO) and MPFL
Always founded
Genuine reflection zone with intertwined
MPFL and VMO fibers Length 25.7 ± 6mm
MPFL ANATOMY
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• 40% of the knee
•
Strong relationshipbetween the MPFL and
the superficial bundle of
the MCL• Ligamentous Arch
Relationship
MPFL / MCL
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Relationship
MPFL / MCL
Ligamentous arch( Smirk et al, Colan et al)
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Femoral Insertion
HAUT
MEDIAL Tubercle of the
great adductor
Femoral MPFL
Insertion
Medial
Epicondyle
11.2 mm
10.7 mm
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Philippot, Chouteau and al (Kssta 2009)
Orthonormal frame centered
on the femoral insertion of the MPFL
F point
• Behind and Proximal to the Medial Epicondyle Point
10.7 ± 3.3mm
• In Front and Distal to the AT point 11.2+5.9mm
Femoral Insertion
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Patellar Insertion
Upper half on the medial
edge of the patella
Also inserted on the patellar
end of the quadriceps tendon
Quadriceps tendon and VMO
( Colan et al, Smirk et al, Tuxoe et al).
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BIOMECHANICS
Strength of the MPFL
• 10 cadaveric specimens (mean age 70 y)
• Mean failure load 208N
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BIOMECHANICSFunction of the MPFL
MPFL load during Flexion
Elias (Am J Sport Med 2006)
Maximum 20N at 30° flexion
Near 0N at 90° flexion
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Control of the patellar lateral
displacement (%)
Conlan (JBJS Am 1993) 53%
Desio (Am J Sport Med 1998) 60% (41-80)
Hautamaa (CORR 1998) 50%
BIOMECHANICS
Function of the MPFL
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From Amis, The Knee 2003
“Graph of patellar lateral displacing force at 10
mm displacement,for the intact knee with 175
N quadriceps tension, and after transection of
the MPFL.The drop between the two curves
shows that the contribution of the MPFL wasgreatest in the extended knee.”
*significant difference.
BIOMECHANICS
Function of the MPFL
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• Specific protocol to evaluate the
function of the MPFL
BIOMECHANICS
Function of the MPFL
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Philippot, Chouteau and al
KSSTA 2010
All three bone segments
marked so that relative
movements of the three segments
could be monitored with respect
to each other and in the six
degrees of freedom
BIOMECHANICS
Function of the MPFL
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Kinematics on the Healthy knee
and after MPFL section
BIOMECHANICS
Function of the MPFL
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Healthy Knee
• Patellar tilt Almost zero through
the first 45° of knee flexion
From 45°, the patella underwent external tiltingwhich became accentuated towards 90° flexion,
reaching a maximum of -3.7 ± 8.9mm with respect to
the reference position
BIOMECHANICS
Function of the MPFL
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BIOMECHANICSFunction of the MPFL
Healthy Knee
• Patellar Shift
• The patella progressively
shifted externally
to reach, at 90° flexion, a maximum shift of 3.18 ±
9.67 mm with respect to the reference position
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BIOMECHANICSFunction of the MPFL
•Healthy Knee
• Patellar Rotation
Through the first 30° of knee flexion, the patella
showed medial rotation, reaching a maximum
amplitude of 0.8 ± 4.6 at 15° of flexion
then a switch to lateral rotation, reaching a maximum
of 1.45 ± 6.5 at 90° flexion
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BIOMECHANICSFunction of the MPFL
Patellar Shift
After section of fibers VMO/MPFL
• No statistically significant modification
After section of the MPFL• Statistically significant Increase in lateral patellar shift
(maximal in extension and decreasing with flexion)
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BIOMECHANICSFunction of the MPFL
Patellar Shift After section of the MPFL
72% increase at full extension, 52% at 90° flexion
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BIOMECHANICSFunction of the MPFL
Lateral Patellar Tilt After section of the MPFL
Statistically significant increase
Maximal in extension
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BIOMECHANICSFunction of the MPFL
Lateral Patellar Tilt Control After section of
the MPFL
MPFL 76% at full extension and 28% at 90° flexion
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Patellar Rotation control Lateral rotation after MPFL section from
extension to 35° flexion
BIOMECHANICSFunction of the MPFL
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Patellar Rotation control after
MPFL section
62% at full extension, 0% from 35°
BIOMECHANICSFunction of the MPFL
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CONCLUSION
MPFL Consistently found in all dissections in the
second thickness of the knee’s medial plane
Main Medial Stabilizer of the Patella
from Full Extension to 30° Flexion
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THANK YOUDr Julien Chouteau PHU MD PHD , Pr Bernard Moyen
Department of Orthopaedics, Trauma and Sport Medicine, Lyon-Sud Hospital, Pierre-Bénite,
France
Julien chouteau@chu-lyon fr