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J Knee Surg 2022; 35(13): 1440-1444
DOI: 10.1055/s-0041-1724131
Original Article

Optimal Fluoroscopic Angulation to Determine Intercondylar Notch Violation during Pediatric Medial Patellofemoral Ligament Reconstruction

Derrick M. Knapik 
1   Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospitals at Case Western Reserve University, Cleveland, Ohio
2   Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
3   Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Conor F. McCarthy
3   Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Ian Drummond
3   Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Raymond W. Liu
1   Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospitals at Case Western Reserve University, Cleveland, Ohio
2   Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
3   Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Allison Gilmore
1   Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospitals at Case Western Reserve University, Cleveland, Ohio
2   Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
3   Case Western Reserve University School of Medicine, Cleveland, Ohio
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Abstract

Previous anatomic data has suggested that during pediatric medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel must be angled distally and anteriorly to avoid damage to the distal femoral physis and then intercondylar notch. The purpose of this study was to determine the optimal degree of fluoroscopic angulation necessary to radiographically determine the presence of intercondylar notch violation. Fourteen adult cadaveric human femora were disarticulated and under fluoroscopic guidance, Schöttle's point was identified. A 0.62-mm Kirschner wire was then drilled through the condyle to create minimal notch violation. The femur was then placed on a level radiolucent table and coronal plane radiographs angled from −15 to 60 degrees were obtained in 5-degree increments to determine the fluoroscopic angle at which intercondylar notch violation was most evident. Grading of optimal fluoroscopic angle between two authors found that violation of the notch was the best appreciated at a mean angle of 43 ± 15 degrees from neutral. Results from this study emphasize the importance of angling the beam to essentially obtain a notch view to assess for a breech.

Keywords

intercondylar notch - medial patellofemoral ligament - drill - physis


Publication History

Received: 19 April 2020

Accepted: 12 January 2021

Article published online:
26 February 2021

© 2021. Thieme. All rights reserved.

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