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J Knee Surg 2017; 30(09): 879-886
DOI: 10.1055/s-0037-1598175
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Accuracy and Learning Curve of Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction

Laurie Anne Hiemstra
1   Department of Orthopedics, Banff Sport Medicine, Banff, Alberta, Canada
2   Department of Surgery, University of Calgary, Calgary, Alberta, Canada
,
Sarah Kerslake
1   Department of Orthopedics, Banff Sport Medicine, Banff, Alberta, Canada
,
Catherine L. O'Brien
1   Department of Orthopedics, Banff Sport Medicine, Banff, Alberta, Canada
,
Mark R. Lafave
3   Department of Health and Physical Education, Mount Royal University, Calgary, Alberta, Canada
› Author Affiliations
Further Information

Publication History

12 February 2016

19 December 2016

Publication Date:
13 February 2017 (online)

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Abstract

The purpose of this study was to assess the accuracy of femoral tunnel placement in a medial patellofemoral ligament reconstruction (MPFL-R) cohort. The secondary purpose was to establish the evidence of a learning curve to achieve acceptable femoral tunnel placement during MPFL-R. Two surgeons, using lateral radiographs, assessed 73 subjects post–MPFL-R. Femoral tunnel accuracy and direction of tunnel error were measured in relation to Schöttle's point (A–T distance). Interrater reliability (intraclass correlation coefficient 2,k) of these measures was calculated. Learning curve of accurate femoral tunnel placement was examined by dividing the patient cohort into quartiles. A one-way analysis of variance was used to assess the quartiles for accuracy of femoral tunnel position and surgical time. In relation to Schöttle's point, 66/73 (90.4%) femoral tunnels were categorized as being in a “good” or “excellent” position and 7/73 (9.6%) were categorized as being in a “poor” position. Evidence of an MPFL-R learning curve was established via a statistically significant difference in the mean A to T distance for the four quartiles (F [3, 69] = 6.41, p = 0.001). There was also a statistically significant difference in the surgical time for the four quartiles (F [3, 69] = 8.71, p = 0.001). In this series, accurate femoral tunnels were placed more than 90% of the time during MPFL-R. A clear learning curve for accurate femoral tunnel placement was demonstrated both with respect to distance of the tunnel from Schöttle point and with regard to surgical time. Level of evidence was IV.

Keywords

patellofemoral instability - patellar - medial patellofemoral ligament reconstruction - learning curve - patella - graft - femoral tunnel position
 

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