Fluoroscopic control allows for precise tunnel positioning in MPFL reconstruction

In MPFL reconstruction, anatomical graft positioning is required to restore physiological joint biomechanics and patellofemoral stability. Considerable rates of non-anatomical femoral tunnel placement exist. The purpose of this study was to analyse whether intraoperative fluoroscopic control is applicable to reduce variability of femoral tunnel positioning. Femoral tunnel positions of 116 consecutive MPFL reconstructions applying intraoperative fluoroscopic images were analysed. Tunnel positions were determined by two independent observers according to Schottle's radiographic measurement method. Mean positions, standard deviations and ranges were calculated to determine the variability of the tunnel positions. Interclass correlation coefficient (ICC) was calculated. The mean anterior/posterior distances from the anatomical insertion of the MPFL to the centre of the femoral tunnel were 2.34 mm (range 0.0-5.9 mm) and 1.7 mm (range 0.1-7.3 mm, SD 1.3) for proximal/distal deviations; 95.7 % (111/116) of femoral tunnel positions were found to be within the anatomical insertion area defined by Schottle. Interobserver tunnel position measurements were highly reliable (ICC: depth 0.979; height 0.979). The study demonstrates that intraoperative fluoroscopic control is a feasible and effective method that enables to create reproducible and precise anatomical femoral tunnel positions in MPFL reconstruction. Accordingly, the routine use of intraoperative fluoroscopy can be recommended. Furthermore, the results indicate Schottle's method as a reliable method for intraoperative control and postoperative analysis of femoral tunnel positioning. IV.