MRI following medial patellofemoral ligament reconstruction: assessment of imaging features found with post-operative pa
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SCIENTIFIC ARTICLE
MRI following medial patellofemoral ligament reconstruction: assessment of imaging features found with post-operative pain, arthritis, and graft failure Tony T. Wong 1 & John Denning 2 & Matthew P. Moy 1 & Michael J. Rasiej 1 & Lauren H. Redler 3 & Christopher S. Ahmad 3 & Charles A. Popkin 3 Received: 8 July 2020 / Revised: 30 September 2020 / Accepted: 16 October 2020 # ISS 2020
Abstract Objective To assess MR features following MPFL reconstruction and determine their influence on post-operative pain, progressive arthritis, or graft failure. Materials and methods Retrospective study on 38 patients with MPFL reconstruction and a post-operative MRI between January 2010 and June 2019. Two radiologists assessed MPFL graft signal, graft thickness, femoral screw, femoral tunnel widening, and patellofemoral cartilage damage. The third performed patellofemoral instability measurements. All three assessed femoral tunnel position with final result determined by majority consensus. Imaging findings were evaluated in the setting of post-operative pain, patellofemoral arthritis, and MPFL graft failure including need for MPFL revision. Statistics included chi-square, Fisher’s exact test, t test, and kappa. Results Mean graft thickness was 6.0 ± 1.8 mm; 24% of the grafts were diffusely hypointense. Mean femoral tunnel widening was 2.5 ± 1.8 mm; 34% of the femoral screws were broken or extruded. Fifty-two percent of the patients had no interval cartilage change. Non-anatomic femoral tunnels were found in 66% of patients, including in all 9 patients requiring revision MPFL reconstruction (p = 0.013). Revised MPFL grafts had more abnormal femoral screws compared to those that did not (67% vs. 24%) (p = 0.019). Other MR features did not significantly influence the evaluated outcomes. Conclusion The need for revision MPFL reconstruction occurs more frequently when there is a non-anatomic femoral tunnel and broken or extruded femoral screws. The appearance of the MPFL graft itself is not an influencing factor for post-operative pain, progression of patellofemoral arthritis, or graft failure. Keywords MPFL reconstruction . Post-operative knee . MRI . Medial patellofemoral ligament . Graft failure
* Tony T. Wong [email protected] John Denning [email protected]
Charles A. Popkin [email protected] 1
Department of Radiology, Division of Musculoskeletal Radiology, New York Presbyterian Hospital – Columbia University Irving Medical Center, 622 W 168th Street, MC-28, New York, NY 10032, USA
2
New York Presbyterian Hospital – Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032, USA
3
Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine, New York Presbyterian Hospital – Columbia University Irving Medical Center, 622 West 168th Street, PH-11, New York, NY 10032, USA
Matthew P. Moy [email protected] Michael J. Rasiej [email protected] Lauren H. Redler [email protected] Christopher S. Ahmad [email protected]
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