title: A Finite Element Analysis of Medial Patellofemoral Ligament Reconstruction.
abstract: BACKGROUND
  The medial patellofemoral ligament is the primary soft-tissue restraint to lateral patella translation. Medial patellofemoral ligament reconstruction has become a viable surgical option to provide patellar stability in patients with recurrent instability. The primary goal of this study was to determine the effect of medial patellofemoral ligament reconstruction on the lateral force-displacement behavior of the patella using finite element analyses.
  
  
  METHODS
  A finite element model of the knee was created using cadaveric image data. Experimental testing was performed to validate the computational model. After validation, the model was modified to study the effect of various medial patellofemoral ligament reconstruction insertion sites, allowing comparison of patellofemoral contact force and pressure.
  
  
  RESULTS
  For the intact anatomic model, the lateral restraining force was 80.0 N with a corresponding patellar contact area of 54.97 mm(2). For the anatomic reconstructed medial patellofemoral ligament model, the lateral restraining force increased to 148.9 N with a contact area of 71.78 mm(2). This compared favorably to the corresponding experimental study. The force required to laterally displace the patella increased when the femoral insertion site was moved anteriorly or distally. The lateral restraining force decreased when the femoral insertion site moved proximally and the patellar insertion site moved either proximal or distal by 5 mm.
  
  
  CONCLUSIONS
  The line of action was altered with insertion site position, which in turn changed the amount of force it took to displace the patella laterally. Considering the model constraints, an anterior femoral attachment may over constrain the patella and increase cartilage wear due to increase contact area and restraining force.
  
  
  CONCLUSIONS
  A malpositioned femoral tunnel in MPFL reconstruction could increase restraining forces and PF contact pressure, thus it is suggested to use intra-operative fluoroscopy to confirm correct tunnel placement.
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa , Iowa City, Iowa , USA 52242 ; Center for Computer Aided Design, The University of Iowa , Iowa City, Iowa , USA 52242.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: DeVries Watson
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa , Iowa City, Iowa , USA 52242.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Duchman
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa , Iowa City, Iowa , USA 52242.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bollier
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa , Iowa City, Iowa , USA 52242 ; Center for Computer Aided Design, The University of Iowa , Iowa City, Iowa , USA 52242 ; Department of Biomedical Engineering, The University of Iowa , Iowa City, Iowa , USA 52242.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Grosland
mesh_terms: D000369:Aged, 80 and over; D001696:Biomechanical Phenomena / Q000502:physiology; D002102:Cadaver; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D031222:Patellar Dislocation / Q000601:surgery*; D017847:Patellar Ligament / Q000601:surgery*; D057071:Patellofemoral Joint / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D013314:Stress, Mechanical; D013718:Tensile Strength / Q000502:physiology*