Reconstruction of the Medial Patellofemoral Ligament Using the Adductor Magnus Tendon: An Anatomic Study
Purpose The aims of this study were to evaluate the anatomic feasibility of medial patellofemoral ligament (MPFL) reconstruction using a part of the adductor magnus tendon and to identify possible risks. Methods Twenty cadaveric knees were dissected. The distal part of the adductor magnus tendon was...
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| Veröffentlicht in: | Arthroscopy 2012, Vol.28 (1), p.105-109 |
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| creator | Jacobi, Matthias, M.D Reischl, Nikolaus, M.D Bergmann, Mathias, M.D Bouaicha, Samy, M.D Djonov, Valentin, M.D Magnussen, Robert A., M.D |
| description | Purpose The aims of this study were to evaluate the anatomic feasibility of medial patellofemoral ligament (MPFL) reconstruction using a part of the adductor magnus tendon and to identify possible risks. Methods Twenty cadaveric knees were dissected. The distal part of the adductor magnus tendon was evaluated with respect to the anatomic topography and its utility for MPFL reconstruction. To estimate the risk of injuring the neurovascular structures, the distance from the adductor tubercle to the adductor hiatus was evaluated. An MPFL reconstruction was carried out by preserving the distal insertion on the adductor tubercle and redirecting the proximal portion of the tendon to the medial aspect of the patella. Results The anatomic investigation showed the following relationships: The mean distance from the adductor tubercle to the adductor hiatus was 99 ± 14 mm (range, 80 to 120 mm). A graft length of 52 ± 5 mm (range, 45 to 63 mm) with the addition of 10 to 20 mm for fixation was found to be necessary for MPFL reconstruction. The difference between the desired graft length and the distance to the adductor hiatus was found to be at least 30 mm in all cases (mean, 46 mm). Leaving the graft attached to the adductor tubercle resulted in a nearly anatomic femoral attachment of the reconstructed MPFL. Complete detachment of the distal adductor magnus attachment was consistently avoidable. Conclusions The adductor magnus tendon was found to be a useful graft for MPFL reconstruction. However, anatomic dangers (damage to the neurovascular bundle of the adductor hiatus, the saphenous nerve, or the saphenous branch of the descending genicular artery) during graft harvest must be considered. Clinical Relevance Anatomic knowledge is essential during adductor magnus tendon harvest to avoid damage to neurovascular structures. The adductor magnus tendon is an interesting alternative graft option for MPFL reconstruction if anatomic dangers are considered and avoided. |
| doi_str_mv | 10.1016/j.arthro.2011.07.015 |
| format | Article |
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Methods Twenty cadaveric knees were dissected. The distal part of the adductor magnus tendon was evaluated with respect to the anatomic topography and its utility for MPFL reconstruction. To estimate the risk of injuring the neurovascular structures, the distance from the adductor tubercle to the adductor hiatus was evaluated. An MPFL reconstruction was carried out by preserving the distal insertion on the adductor tubercle and redirecting the proximal portion of the tendon to the medial aspect of the patella. Results The anatomic investigation showed the following relationships: The mean distance from the adductor tubercle to the adductor hiatus was 99 ± 14 mm (range, 80 to 120 mm). A graft length of 52 ± 5 mm (range, 45 to 63 mm) with the addition of 10 to 20 mm for fixation was found to be necessary for MPFL reconstruction. The difference between the desired graft length and the distance to the adductor hiatus was found to be at least 30 mm in all cases (mean, 46 mm). Leaving the graft attached to the adductor tubercle resulted in a nearly anatomic femoral attachment of the reconstructed MPFL. Complete detachment of the distal adductor magnus attachment was consistently avoidable. Conclusions The adductor magnus tendon was found to be a useful graft for MPFL reconstruction. However, anatomic dangers (damage to the neurovascular bundle of the adductor hiatus, the saphenous nerve, or the saphenous branch of the descending genicular artery) during graft harvest must be considered. Clinical Relevance Anatomic knowledge is essential during adductor magnus tendon harvest to avoid damage to neurovascular structures. The adductor magnus tendon is an interesting alternative graft option for MPFL reconstruction if anatomic dangers are considered and avoided.</description><identifier>ISSN: 0749-8063</identifier><identifier>EISSN: 1526-3231</identifier><identifier>DOI: 10.1016/j.arthro.2011.07.015</identifier><identifier>PMID: 22001735</identifier><identifier>CODEN: ARTHE3</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Arthroscopy ; Biological and medical sciences ; Biomechanical Phenomena ; Cadaver ; Endoscopy ; Female ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medial Collateral Ligament, Knee - surgery ; Medical sciences ; Orthopedic surgery ; Orthopedics ; Patellar Ligament - surgery ; Reconstructive Surgical Procedures - methods ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Tendons - surgery ; Tensile Strength ; Tissue Transplantation - methods</subject><ispartof>Arthroscopy, 2012, Vol.28 (1), p.105-109</ispartof><rights>Arthroscopy Association of North America</rights><rights>2012 Arthroscopy Association of North America</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-96bc7d66f77361abdd99f257089abc07dd634494ed34f712de641ab72a23094f3</citedby><cites>FETCH-LOGICAL-c446t-96bc7d66f77361abdd99f257089abc07dd634494ed34f712de641ab72a23094f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arthro.2011.07.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,4022,27922,27923,27924,45994</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25654905$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22001735$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jacobi, Matthias, M.D</creatorcontrib><creatorcontrib>Reischl, Nikolaus, M.D</creatorcontrib><creatorcontrib>Bergmann, Mathias, M.D</creatorcontrib><creatorcontrib>Bouaicha, Samy, M.D</creatorcontrib><creatorcontrib>Djonov, Valentin, M.D</creatorcontrib><creatorcontrib>Magnussen, Robert A., M.D</creatorcontrib><title>Reconstruction of the Medial Patellofemoral Ligament Using the Adductor Magnus Tendon: An Anatomic Study</title><title>Arthroscopy</title><addtitle>Arthroscopy</addtitle><description>Purpose The aims of this study were to evaluate the anatomic feasibility of medial patellofemoral ligament (MPFL) reconstruction using a part of the adductor magnus tendon and to identify possible risks. Methods Twenty cadaveric knees were dissected. The distal part of the adductor magnus tendon was evaluated with respect to the anatomic topography and its utility for MPFL reconstruction. To estimate the risk of injuring the neurovascular structures, the distance from the adductor tubercle to the adductor hiatus was evaluated. An MPFL reconstruction was carried out by preserving the distal insertion on the adductor tubercle and redirecting the proximal portion of the tendon to the medial aspect of the patella. Results The anatomic investigation showed the following relationships: The mean distance from the adductor tubercle to the adductor hiatus was 99 ± 14 mm (range, 80 to 120 mm). A graft length of 52 ± 5 mm (range, 45 to 63 mm) with the addition of 10 to 20 mm for fixation was found to be necessary for MPFL reconstruction. The difference between the desired graft length and the distance to the adductor hiatus was found to be at least 30 mm in all cases (mean, 46 mm). Leaving the graft attached to the adductor tubercle resulted in a nearly anatomic femoral attachment of the reconstructed MPFL. Complete detachment of the distal adductor magnus attachment was consistently avoidable. Conclusions The adductor magnus tendon was found to be a useful graft for MPFL reconstruction. However, anatomic dangers (damage to the neurovascular bundle of the adductor hiatus, the saphenous nerve, or the saphenous branch of the descending genicular artery) during graft harvest must be considered. Clinical Relevance Anatomic knowledge is essential during adductor magnus tendon harvest to avoid damage to neurovascular structures. The adductor magnus tendon is an interesting alternative graft option for MPFL reconstruction if anatomic dangers are considered and avoided.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthroscopy</subject><subject>Biological and medical sciences</subject><subject>Biomechanical Phenomena</subject><subject>Cadaver</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medial Collateral Ligament, Knee - surgery</subject><subject>Medical sciences</subject><subject>Orthopedic surgery</subject><subject>Orthopedics</subject><subject>Patellar Ligament - surgery</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Tendons - surgery</subject><subject>Tensile Strength</subject><subject>Tissue Transplantation - methods</subject><issn>0749-8063</issn><issn>1526-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl2LEzEUhoMobl39ByJzI15NPfmYpPFCKItf0EVxd69DmmTa1JlkTTJC_70ZWxW8EQIh8LznnDwchJ5jWGLA_PVhqVPZp7gkgPESxBJw9wAtcEd4SwnFD9ECBJPtCji9QE9yPgAApSv6GF0QAoAF7RZo_9WZGHJJkyk-hib2Tdm75tpZr4fmiy5uGGLvxpjqc-N3enShNHfZh90vcG1tTcbUXOtdmHJz64KN4U2zDvXoEkdvmpsy2eNT9KjXQ3bPzvclunv_7vbqY7v5_OHT1XrTGsZ4aSXfGmE574WgHOuttVL2pBOwknprQFjLKWOSOUtZLzCxjrOKCaIJBcl6eolenerep_h9crmo0WdTf6GDi1NWEhMhOWFdJdmJNCnmnFyv7pMfdToqDGpWrA7qpFjNihUIVRXX2Itzg2k7Ovsn9NtpBV6eAZ2NHvqkg_H5L9fxjkmYubcnzlUdP7xLKhvvgqnqkzNF2ej_N8m_Bczgg689v7mjy4c4pVBVK6wyUaBu5nWYtwFjAC6koD8BC2ewzQ</recordid><startdate>2012</startdate><enddate>2012</enddate><creator>Jacobi, Matthias, M.D</creator><creator>Reischl, Nikolaus, M.D</creator><creator>Bergmann, Mathias, M.D</creator><creator>Bouaicha, Samy, M.D</creator><creator>Djonov, Valentin, M.D</creator><creator>Magnussen, Robert A., M.D</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2012</creationdate><title>Reconstruction of the Medial Patellofemoral Ligament Using the Adductor Magnus Tendon: An Anatomic Study</title><author>Jacobi, Matthias, M.D ; Reischl, Nikolaus, M.D ; Bergmann, Mathias, M.D ; Bouaicha, Samy, M.D ; Djonov, Valentin, M.D ; Magnussen, Robert A., M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-96bc7d66f77361abdd99f257089abc07dd634494ed34f712de641ab72a23094f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthroscopy</topic><topic>Biological and medical sciences</topic><topic>Biomechanical Phenomena</topic><topic>Cadaver</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medial Collateral Ligament, Knee - surgery</topic><topic>Medical sciences</topic><topic>Orthopedic surgery</topic><topic>Orthopedics</topic><topic>Patellar Ligament - surgery</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Tendons - surgery</topic><topic>Tensile Strength</topic><topic>Tissue Transplantation - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jacobi, Matthias, M.D</creatorcontrib><creatorcontrib>Reischl, Nikolaus, M.D</creatorcontrib><creatorcontrib>Bergmann, Mathias, M.D</creatorcontrib><creatorcontrib>Bouaicha, Samy, M.D</creatorcontrib><creatorcontrib>Djonov, Valentin, M.D</creatorcontrib><creatorcontrib>Magnussen, Robert A., M.D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Arthroscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jacobi, Matthias, M.D</au><au>Reischl, Nikolaus, M.D</au><au>Bergmann, Mathias, M.D</au><au>Bouaicha, Samy, M.D</au><au>Djonov, Valentin, M.D</au><au>Magnussen, Robert A., M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reconstruction of the Medial Patellofemoral Ligament Using the Adductor Magnus Tendon: An Anatomic Study</atitle><jtitle>Arthroscopy</jtitle><addtitle>Arthroscopy</addtitle><date>2012</date><risdate>2012</risdate><volume>28</volume><issue>1</issue><spage>105</spage><epage>109</epage><pages>105-109</pages><issn>0749-8063</issn><eissn>1526-3231</eissn><coden>ARTHE3</coden><abstract>Purpose The aims of this study were to evaluate the anatomic feasibility of medial patellofemoral ligament (MPFL) reconstruction using a part of the adductor magnus tendon and to identify possible risks. Methods Twenty cadaveric knees were dissected. The distal part of the adductor magnus tendon was evaluated with respect to the anatomic topography and its utility for MPFL reconstruction. To estimate the risk of injuring the neurovascular structures, the distance from the adductor tubercle to the adductor hiatus was evaluated. An MPFL reconstruction was carried out by preserving the distal insertion on the adductor tubercle and redirecting the proximal portion of the tendon to the medial aspect of the patella. Results The anatomic investigation showed the following relationships: The mean distance from the adductor tubercle to the adductor hiatus was 99 ± 14 mm (range, 80 to 120 mm). A graft length of 52 ± 5 mm (range, 45 to 63 mm) with the addition of 10 to 20 mm for fixation was found to be necessary for MPFL reconstruction. The difference between the desired graft length and the distance to the adductor hiatus was found to be at least 30 mm in all cases (mean, 46 mm). Leaving the graft attached to the adductor tubercle resulted in a nearly anatomic femoral attachment of the reconstructed MPFL. Complete detachment of the distal adductor magnus attachment was consistently avoidable. Conclusions The adductor magnus tendon was found to be a useful graft for MPFL reconstruction. However, anatomic dangers (damage to the neurovascular bundle of the adductor hiatus, the saphenous nerve, or the saphenous branch of the descending genicular artery) during graft harvest must be considered. Clinical Relevance Anatomic knowledge is essential during adductor magnus tendon harvest to avoid damage to neurovascular structures. The adductor magnus tendon is an interesting alternative graft option for MPFL reconstruction if anatomic dangers are considered and avoided.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>22001735</pmid><doi>10.1016/j.arthro.2011.07.015</doi><tpages>5</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Arthroscopy Biological and medical sciences Biomechanical Phenomena Cadaver Endoscopy Female Humans Investigative techniques, diagnostic techniques (general aspects) Male Medial Collateral Ligament, Knee - surgery Medical sciences Orthopedic surgery Orthopedics Patellar Ligament - surgery Reconstructive Surgical Procedures - methods Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tendons - surgery Tensile Strength Tissue Transplantation - methods |
| title | Reconstruction of the Medial Patellofemoral Ligament Using the Adductor Magnus Tendon: An Anatomic Study |
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