Computational Approach to Correcting Joint Instability in Patients with Recurrent Patellar Dislocation

Oliver Alvarez, Robert N. Steensen, Paul J. Rullkoetter, Clare K. Fitzpatrick

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Patellar dislocation is a debilitating injury common in active adolescents and young adults. Conservative treatment after initial dislocation is often recommended, but almost half of these patients continue to suffer from recurrent dislocation. The objective of this study was to compare preoperative patellofemoral joint stability with stability after a series of simulated procedures, including restorative surgery to correct to pre-injury state, generic tibial tubercle osteotomy, patient-specific reconstructive surgery to correct anatomic abnormality, less invasive patient-specific surgery, and equivalent healthy controls . Three-dimensional, subject-specific finite element models of the patellofemoral joint were developed for 28 patients with recurrent patellar dislocation. A 50 N lateral load was applied to the patella to assess the lateral stability of the patellofemoral joint at 10° intervals from 0° to 40° flexion. Medial patellofemoral ligament reconstruction, along with reconstructive procedures to correct anatomic abnormality were simulated. Of all the simulations performed, the healthy equivalent control models showed the least patellar internal–external rotation, medial–lateral translation, and medial patellofemoral ligament restraining load during lateral loading tests. Isolated restorative medial patellofemoral ligament reconstruction was the surgery that resulted in the most patellar internal–external rotation, medial–lateral translation, and medial patellofemoral ligament reaction force across all flexion angles. Patient-specific reconstruction to correct anatomic abnormality was the only surgical group to have non-significantly different results compared with the healthy equivalent control group across all joint stability metrics evaluated. Statement of clinical significance: This study suggests patient-specific reconstructive surgery that corrects underlying anatomic abnormalities best reproduces the joint stability of an equivalent healthy control when compared with the pre-injury state, generic tibial tubercle osteotomy, and less invasive patient-specific surgery.

Original languageAmerican English
Pages (from-to)768-776
Number of pages9
JournalJournal of Orthopaedic Research
Volume38
Issue number4
DOIs
StatePublished - Apr 2020

Keywords

  • finite element
  • patellar dislocation
  • patellar instability
  • patellofemoral joint mechanics
  • surgery

EGS Disciplines

  • Biomedical Engineering and Bioengineering
  • Mechanical Engineering
  • Orthopedics

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