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Lateral to medial fluoroscopic view improves the accuracy of identifying the MPFL femoral footprint using Schottle's technique. | LitMetric

AI Article Synopsis

  • - The study evaluated how different fluoroscopic settings affect the accuracy of finding Schottle's point during medial patellofemoral ligament (MPFL) reconstruction, using 44 dry femurs.
  • - Results showed that the lateral-to-medial (LM) view significantly reduced the distance from the anatomical MPFL footprint to Schottle's point compared to the medial-to-lateral (ML) view, resulting in a higher percentage of acceptable tunnel locations.
  • - The findings suggest that using the LM fluoroscopic view can enhance the accuracy of femoral tunnel placement, leading to better surgical outcomes by more accurately replicating the native MPFL.

Article Abstract

Purpose: This study investigated the effect of different fluoroscopy settings on the accuracy of locating Schottle's point during medial patellofemoral ligament (MPFL) reconstruction.

Methods: The centre of the MPFL femoral footprint was identified and marked on 44 dry femurs. Two standard true lateral knee fluoroscopic images were obtained: (1) medial to lateral (ML) and (2) lateral to medial (LM). The deviation between the anatomically determined MPFL femoral footprint and the fluoroscopically identified point was measured on both fluoroscopic images. An 'acceptable tunnel location' was defined as within a 5- or 7-mm margin of error from the anatomic MPFL footprint. Distal femoral morphometric dimensions were also measured using digital calipers. Statistical analysis determined discrepancies between techniques and their relation to femoral morphometry.

Results: The LM view yielded a significantly smaller distance between the anatomical MPFL footprint and Schottle's point compared to the ML view (3.2 ± 1.5 vs. 4.5 ± 2.1 mm, p < 0.001). The LM view achieved acceptable tunnel locations, meeting the 5-mm error criterion in 90.9% of cases, while the ML view achieved 65.9% (p < 0.001). Both views yielded acceptable tunnel locations at similar rates using the 7-mm error criterion (n.s.). The anatomic MPFL footprint was displaced towards the anterior and proximal location in the ML view in reference to the Schottle point. No correlation was observed between any of the morphometric measurements and the deviations.

Conclusions: This study demonstrated that using the LM fluoroscopic view improves the accuracy of femoral tunnel placement when identifying the MPFL footprint via the Schottle technique. Adopting the LM view in surgical practice will help surgeons locate the anatomical femoral footprint accurately, replicating the native MPFL and enhancing clinical outcomes.

Level Of Evidence: Level 4, cadaveric study.

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Source
http://dx.doi.org/10.1002/ksa.12373DOI Listing

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