AN MRI STUDY DEMONSTRATING CONSISTENT ANATOMIC RELATION OF THE CENTRAL LONGITUDINAL ARTERY AND ASSOCIATED PERIOSTEAL VESSELS WITH THE MEDIAL FEMORAL EPICONDYLE AND ADDUCTOR TUBERCLE: A VISUAL LANDMARK METHOD FOR FEMORAL TUNNEL PLACEMENT IN MPFL RECONSTRUCTION

V. Mandalia; R. Anaspure; S. Aboelmagd; R. Powell; W. Manning

doi:10.1302/1358-992X.2022.7.066

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AN MRI STUDY DEMONSTRATING CONSISTENT ANATOMIC RELATION OF THE CENTRAL LONGITUDINAL ARTERY AND ASSOCIATED PERIOSTEAL VESSELS WITH THE MEDIAL FEMORAL EPICONDYLE AND ADDUCTOR TUBERCLE: A VISUAL LANDMARK METHOD FOR FEMORAL TUNNEL PLACEMENT IN MPFL RECONSTRUCTION

The British Association for Surgery of the Knee (BASK) May 2022 Meeting, Newport, Wales, 17–18 May 2022.

V. Mandalia
R. Anaspure
S. Aboelmagd
R. Powell
W. Manning

AN MRI STUDY DEMONSTRATING CONSISTENT ANATOMIC RELATION OF THE CENTRAL LONGITUDINAL ARTERY AND ASSOCIATED PERIOSTEAL VESSELS WITH THE MEDIAL FEMORAL EPICONDYLE AND ADDUCTOR TUBERCLE: A VISUAL LANDMARK METHOD FOR FEMORAL TUNNEL PLACEMENT IN MPFL RECONSTRUCTION

Mandalia V, Anaspure R, Aboelmagd S, Powell R, Manning W. AN MRI STUDY DEMONSTRATING CONSISTENT ANATOMIC RELATION OF THE CENTRAL LONGITUDINAL ARTERY AND ASSOCIATED PERIOSTEAL VESSELS WITH THE MEDIAL FEMORAL EPICONDYLE AND ADDUCTOR TUBERCLE: A VISUAL LANDMARK METHOD FOR FEMORAL TUNNEL PLACEMENT IN MPFL RECONSTRUCTION. Orthop Procs. 2022;104-B(SUPP_7):66-66. doi:10.1302/1358-992X.2022.7.066

Mandalia, V., et al. “AN MRI STUDY DEMONSTRATING CONSISTENT ANATOMIC RELATION OF THE CENTRAL LONGITUDINAL ARTERY AND ASSOCIATED PERIOSTEAL VESSELS WITH THE MEDIAL FEMORAL EPICONDYLE AND ADDUCTOR TUBERCLE: A VISUAL LANDMARK METHOD FOR FEMORAL TUNNEL PLACEMENT IN MPFL RECONSTRUCTION.” Orthopaedic Proceedings, vol. 104-B, no. SUPP_7, 2022, pp. 66-66., https://doi.org/10.1302/1358-992X.2022.7.066

Mandalia, V., Anaspure, R., Aboelmagd, S., Powell, R., & Manning, W. (2022). AN MRI STUDY DEMONSTRATING CONSISTENT ANATOMIC RELATION OF THE CENTRAL LONGITUDINAL ARTERY AND ASSOCIATED PERIOSTEAL VESSELS WITH THE MEDIAL FEMORAL EPICONDYLE AND ADDUCTOR TUBERCLE: A VISUAL LANDMARK METHOD FOR FEMORAL TUNNEL PLACEMENT IN MPFL RECONSTRUCTION. Orthopaedic Proceedings, 104-B(SUPP_7), 66-66. https://doi.org/10.1302/1358-992X.2022.7.066

Mandalia, V., Anaspure, R., Aboelmagd, S., Powell, R. and Manning, W. (2022) “AN MRI STUDY DEMONSTRATING CONSISTENT ANATOMIC RELATION OF THE CENTRAL LONGITUDINAL ARTERY AND ASSOCIATED PERIOSTEAL VESSELS WITH THE MEDIAL FEMORAL EPICONDYLE AND ADDUCTOR TUBERCLE: A VISUAL LANDMARK METHOD FOR FEMORAL TUNNEL PLACEMENT IN MPFL RECONSTRUCTION.” Orthopaedic Proceedings, 104-B(SUPP_7), pp. 66-66. Available at: https://doi.org/10.1302/1358-992X.2022.7.066

Mandalia, V., R. Anaspure, S. Aboelmagd, R. Powell, and W. Manning. “AN MRI STUDY DEMONSTRATING CONSISTENT ANATOMIC RELATION OF THE CENTRAL LONGITUDINAL ARTERY AND ASSOCIATED PERIOSTEAL VESSELS WITH THE MEDIAL FEMORAL EPICONDYLE AND ADDUCTOR TUBERCLE: A VISUAL LANDMARK METHOD FOR FEMORAL TUNNEL PLACEMENT IN MPFL RECONSTRUCTION.” Orthopaedic Proceedings 104-B, no. SUPP_7 (2022): 66-66. https://doi.org/10.1302/1358-992X.2022.7.066

Mandalia V, Anaspure R, Aboelmagd S, Powell R, Manning W. AN MRI STUDY DEMONSTRATING CONSISTENT ANATOMIC RELATION OF THE CENTRAL LONGITUDINAL ARTERY AND ASSOCIATED PERIOSTEAL VESSELS WITH THE MEDIAL FEMORAL EPICONDYLE AND ADDUCTOR TUBERCLE: A VISUAL LANDMARK METHOD FOR FEMORAL TUNNEL PLACEMENT IN MPFL RECONSTRUCTION. Orthop Procs. 2022 Jul 1;104-B(SUPP_7):66-66. https://doi.org/10.1302/1358-992X.2022.7.066

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Abstract

The radiographic or bony landmark techniques are the two most common methods to determine Medial patellofemoral ligament (MPFL) femoral tunnel placement. Their intra/inter-observer reliability is widely debated. The palpation technique relies on identifying the medial epicondyle (ME) and adductor Tubercle (AT). The central longitudinal artery and associated vessels (CLV) are consistently seen in the surgical dissection during MPFL reconstruction. The aim of this study was to investigate the anatomic relationship of CLV to ME-AT and thereby use CLV as an important vascular landmark during MPFL reconstruction.

A retrospective review of MRI scans in skeletally mature patients presenting to a tertiary referral knee clinic was undertaken. Group-N consisted of any presentation without patellofemoral instability or malalignment (PFI). Group-P with PFI. MRI's were reviewed and measured by two Consultant Radiologists for the CLV-ME-AT anatomy and relationship.

Following exclusions 50 patients were identified in each group. The CLV passed anterior to the AT and ME in all patients. ME morphology did not differ greatly between the groups except in the tubercle height, where there was a statically but not clinically significant difference (larger in the non-PFI group, 2.95mm vs 2.52mm, p=0.002). The CLV to ME Tip distance was consistent between the groups (Group PFI group 3.8mm & ‘normal’ non-PFI Group 3.9mm).

The CLV-ME-AT relationship remained consistent despite patients presenting pathology. The CLV consistently courses anterior to ME and AT. The CLV could be used as a vascular landmark assisting femoral tunnel placement during MPFL reconstruction.