title: Reliability of radiographic landmarks in medial patello-femoral ligament reconstruction in relation to the anatomical femoral torsion.
abstract: OBJECTIVE
  Anatomically correct graft positioning at the femoral insertion site is a key factor in surgical reconstruction of the medial patello-femoral ligament (MPFL). Basically there are two techniques to define this point in fluoroscopy during surgery. The role of the anatomical femoral torsion on the accuracy and reproducibility of both procedures has not been clarified.
  
  
  METHODS
  Twenty human anatomical leg specimens were dissected. The femoral insertion of the MPFL was marked by two K-wires. The position of the ligament insertion was determined fluoroscopically in the true lateral view as used in routine clinical practice. The anatomical MPFL insertion was compared to the radiographic landmarks which were recommended by two previous studies. The anatomical femoral torsion of the specimens was assessed by computed tomography scans.
  
  
  RESULTS
  In true lateral view fluoroscopy, the mean distance of the femoral MPFL insertion was -0.2 mm distal to the vertical reference line intersecting the posterior point of Blumensaat's line. In the anteroposterior direction, the mean distance was -2.0 mm posterior to the femoral cortex reference line. There was no correlation between anatomical femoral torsion and the distance of the femoral MPFL insertion to the posterior cortex.
  
  
  CONCLUSIONS
  The results of this study strongly recommend use of a vertical line intersecting the most posterior point of Blumensaat's line as a reference to identify the MPFL insertion in the craniocaudal direction. In the anteroposterior direction, the femoral MPFL insertion showed distinctive variation and was found -2.0 mm posterior to the femoral cortex reference line without being influenced by the anatomical femoral torsion.
authors.affiliation: Department of Traumatology, Barmherzige Brüder Hospital, Johannes von Gott Platz 1, 7000, Eisenstadt, Austria, martin.kaipel@bbeisen.at.
authors.forename: Martin
authors.initials: M
authors.lastname: Kaipel
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schützenberger
authors.forename: Sebastian
authors.initials: S
authors.lastname: Farr
authors.forename: Istvan
authors.initials: I
authors.lastname: Gergely
authors.forename: Alexander
authors.initials: A
authors.lastname: Vlcek
authors.forename: Franz
authors.initials: F
authors.lastname: Kainberger
authors.forename: Harald
authors.initials: H
authors.lastname: Boszotta
authors.forename: Michael
authors.initials: M
authors.lastname: Pretterklieber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000601:surgery; D005471:Fluoroscopy; D006801:Humans; D008023:Ligaments, Articular / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D057071:Patellofemoral Joint / Q000601:surgery*; D010388:Pelvis / Q000000981:diagnostic imaging; D019651:Plastic Surgery Procedures; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000000981:diagnostic imaging*