open access

Vol 77, No 4 (2018)
ORIGINAL ARTICLES
Published online: 2018-03-30
Submitted: 2018-01-27
Accepted: 2018-03-08
Get Citation

Cadaveric-biomechanical study on medial retinaculum: its stabilising role for the patella against lateral dislocation

L. Mitrogiannis, A. Barbouti, P. Kanavaros, G. Paraskevas, A. Kitsouli, G. Mitrogiannis, P. Kitsoulis
DOI: 10.5603/FM.a2018.0032
·
Pubmed: 29611163
·
Folia Morphol 2018;77(4):742-747.

open access

Vol 77, No 4 (2018)
ORIGINAL ARTICLES
Published online: 2018-03-30
Submitted: 2018-01-27
Accepted: 2018-03-08

Abstract

Background: The aim of this study was to analyse the biomechanical role of medial retinaculum, as a stabilising factor against lateral patellar dislocation.

Materials and methods: This cadaveric-biomechanical study included the patellae of 10 cadaveric knees, which were surgically exposed and the medial retinaculum of each one was located. A stable 24.51 N force was applied to the four parts of the quadriceps, and an increasing lateral displacing force was applied to the patella, up to 5 mm dislocation. The study was repeated for 0o, 45o, and 90o of knee flexion, with the medial retinaculum intact and dissected. The Wilcoxon signed rank test was used for data analysis. A p value < 0.05 was considered as statistical significant.

Results: After the dissection of medial retinaculum, the lateral displacement force was lower at every angle of knee flexion (p = 0.005, p = 0.007, p = 0.005, respectively). The lateral displacement force increased as the flexion angle increased (p = 0.005), regardless of medial retinaculum integrity.

Conclusions: Medial retinaculum acts as a stabilising factor for the patella, against its lateral dislocation in lower flexion angles. Therefore, methods of surgical reinforcement or repair of medial retinaculum could provide protection against
recurrent patellar dislocation.

Abstract

Background: The aim of this study was to analyse the biomechanical role of medial retinaculum, as a stabilising factor against lateral patellar dislocation.

Materials and methods: This cadaveric-biomechanical study included the patellae of 10 cadaveric knees, which were surgically exposed and the medial retinaculum of each one was located. A stable 24.51 N force was applied to the four parts of the quadriceps, and an increasing lateral displacing force was applied to the patella, up to 5 mm dislocation. The study was repeated for 0o, 45o, and 90o of knee flexion, with the medial retinaculum intact and dissected. The Wilcoxon signed rank test was used for data analysis. A p value < 0.05 was considered as statistical significant.

Results: After the dissection of medial retinaculum, the lateral displacement force was lower at every angle of knee flexion (p = 0.005, p = 0.007, p = 0.005, respectively). The lateral displacement force increased as the flexion angle increased (p = 0.005), regardless of medial retinaculum integrity.

Conclusions: Medial retinaculum acts as a stabilising factor for the patella, against its lateral dislocation in lower flexion angles. Therefore, methods of surgical reinforcement or repair of medial retinaculum could provide protection against
recurrent patellar dislocation.

Get Citation

Keywords

patellar instability, patellar retinaculum, medial stabilisers, lateral displacement force, medial patellofemoral ligament

About this article
Title

Cadaveric-biomechanical study on medial retinaculum: its stabilising role for the patella against lateral dislocation

Journal

Folia Morphologica

Issue

Vol 77, No 4 (2018)

Pages

742-747

Published online

2018-03-30

DOI

10.5603/FM.a2018.0032

Pubmed

29611163

Bibliographic record

Folia Morphol 2018;77(4):742-747.

Keywords

patellar instability
patellar retinaculum
medial stabilisers
lateral displacement force
medial patellofemoral ligament

Authors

L. Mitrogiannis
A. Barbouti
P. Kanavaros
G. Paraskevas
A. Kitsouli
G. Mitrogiannis
P. Kitsoulis

References (21)
  1. Cerciello S, Lustig S, Costanzo G, et al. Medial retinaculum reefing for the treatment for patellar instability. Knee Surg Sports Traumatol Arthrosc. 2014; 22(10): 2505–2512.
  2. Coons DA, Barber FA. Thermal medial retinaculum shrinkage and lateral release for the treatment of recurrent patellar instability. Arthroscopy. 2006; 22(2): 166–171.
  3. Dainer RD, Barrack RL, Buckley SL, et al. Arthroscopic treatment of acute patellar dislocations. Arthroscopy. 1988; 4(4): 267–271.
  4. Duchman KR, DeVries NA, McCarthy MA, et al. Biomechanical evaluation of medial patellofemoral ligament reconstruction. Iowa Orthop J. 2013; 33: 64–69.
  5. Ebied AM, El-Kholy W. Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability. Knee Surg Sports Traumatol Arthrosc. 2012; 20(5): 926–932.
  6. Farahmand F, Naghi Tahmasbi M, Amis A. The contribution of the medial retinaculum and quadriceps muscles to patellar lateral stability--an in-vitro study. Knee. 2004; 11(2): 89–94.
  7. Frosch S, Balcarek P, Walde TA, et al. [The treatment of patellar dislocation: a systematic review]. Z Orthop Unfall. 2011; 149(6): 630–645.
  8. Ma LF, Wang F, Chen BC, et al. Medial retinaculum plasty versus medial patellofemoral ligament reconstruction for recurrent patellar instability in adults: a randomized controlled trial. Arthroscopy. 2013; 29(5): 891–897.
  9. Meyers AB, Laor T, Sharafinski M, et al. Imaging assessment of patellar instability and its treatment in children and adolescents. Pediatr Radiol. 2016; 46(5): 618–636.
  10. Mikashima Y, Kimura M, Kobayashi Y, et al. Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella. Acta Orthop Belg. 2006; 72(1): 65–71.
  11. Neri T, Philippot R, Carnesecchi O, et al. Medial patellofemoral ligament reconstruction: clinical and radiographic results in a series of 90 cases. Orthop Traumatol Surg Res. 2015; 101(1): 65–69.
  12. Ostermeier S, Stukenborg-Colsman C, Hurschler C, et al. In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patellar stability. Arthroscopy. 2006; 22(3): 308–319.
  13. Panagiotopoulos E, Strzelczyk P, Herrmann M, et al. Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2006; 14(1): 7–12.
  14. Rillmann P, Fischer A, Berbig R, et al. [Arthroscopic repair of the medial retinaculum after first time dislocation of the patella]. Unfallchirurg. 1999; 102(3): 167–172.
  15. Schöttle PB, Scheffler SU, Schwarck A, et al. Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: a preliminary report. Arthroscopy. 2006; 22(11): 1192–1198.
  16. Shelbourne KD, Urch SE, Gray T. Results of medial retinacular imbrication in patients with unilateral patellar dislocation. J Knee Surg. 2012; 25(5): 391–396.
  17. Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am. 1979; 61(1): 56–62.
  18. Yamamoto RK. Arthroscopic repair of the medial retinaculum and capsule in acute patellar dislocations. Arthroscopy. 1986; 2(2): 125–131.
  19. Zaffagnini S, Colle F, Lopomo N, et al. The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc. 2013; 21(9): 2164–2171.
  20. Zhao J, Huangfu X, He Y, et al. Recurrent patellar dislocation in adolescents: medial retinaculum plication versus vastus medialis plasty. Am J Sports Med. 2012; 40(1): 123–132.
  21. Zhao J, Huangfu X, He Y. The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med. 2012; 40(6): 1355–1364.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By  "Via Medica sp. z o.o." sp.k., Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl