MPFL reconstruction using a quadriceps tendon graft: Part 1: Biomechanical properties of quadriceps tendon MPFL reconstruction in comparison to the Intact MPFL. A human cadaveric study

•Analysis of the structural properties of the original MPFL•Analysis of the structural properties of a new quad tendon MPFL-reconstruction•Quad-tendon technique similar structural properties compared to the original MPFL

BackgroundThe aim of this study was to analyze the structural properties of the original MPFL and to compare it to a MPFL-reconstruction-technique using a strip of quadriceps tendon.MethodsIn 13 human cadaver knees the MPFLs were dissected protecting their insertion at the patellar border. The MPFL was loaded to failure after preconditioning with 10 cycles in a uniaxial testing machine evaluating stiffness, yield load and maximum load to failure. In the second part Quadriceps-MPFL-reconstruction was performed and tested in a uniaxial testing machine. Following preconditioning, the constructs were cyclically loaded 1000 times between 5 and 50 N measuring the maximum elongation. After cyclic testing, the constructs have been loaded to failure measuring stiffness, yield load and maximum load. For statistical analysis a repeated measures (RM) one-way ANOVA for multiple comparisons was used. The significance was set at P < 0.05.ResultsDuring the load to failure tests of the original MPFL the following results were measured: stiffness 29.4 N/mm (+ 9.8), yield load 167.8 N (+ 80) and maximum load to failure 190.7 N (+ 82.8). The results in the QT-technique group were as follows: maximum elongation after 1000 cycles 2.1 mm (+ 0.8), stiffness 33.6 N/mm (+ 6.8), yield load 147.1 N (+ 65.1) and maximum load to failure 205 N (+ 77.8). There were no significant differences in all tested parameters.ConclusionsIn a human cadaveric model using a strip of quadriceps-tendon 10 mm wide and 3 mm deep, the biomechanical properties match those of the original MPFL when tested as a reconstruction.Clinical relevanceThe tested QT-technique shows sufficient primary stability with comparable biomechanical parameters to the intact MPFL.