Accuracy of Schottle's point location by palpation and its role in clinical outcome after medial patellofemoral ligament reconstruction

Vivek Pandey, Kiran Kumar Mannava, Nivedita Zakhar, Bhavya Mody, Kiran Acharya

Research output: Contribution to journalArticle

Abstract

Introduction: Medial patellofemoral ligament (MPFL) reconstruction is performed for the recurrent patellar dislocation (RPD). The crux of sound clinical results depends upon accurate placement of the graft at or within the 7-mm circle of Schottle point (acceptable position) over the femur. Most studies recommend the location of Schottle's point using intraoperative fluoroscopy or seldom by clinical palpation. We conducted a clinical study to understand the accuracy of locating Schottle's point by clinical palpation and its effect on outcome after MPFL reconstruction. Method: 30 patients with RPD were included in this retrospective study after MPFL reconstruction. Post-operative CTscan was performed to locate the position of the femoral tunnel using Servien grid criteria and Schottle's point location. The clinical outcome was assessed using Lysholm and Kujala Scores at the end of a minimum of two years. Results: 30 patients (11 male, 19 female) with a mean age of 24.8 years (range, 16–45 years) were followed for a mean of 42 months (range, 24–96 months). Mean Kujala score improved from 53.8 to 91.5 (p = 0.0001), and Lysholm score improved from 59.0 to 93.3 (p = 0.0001) in all 30 patients. Post-operative CT assessment revealed 19 patients (63.3%) had a tunnel in an acceptable position and 11 patients (36.7%) in an unacceptable position. Eight of the eleven unacceptable tunnels were placed in the anteroposterior direction, and three in superior-inferior direction. However, there was no significant difference between the Lysholm and Kujala scores of patients with acceptable versus unacceptable tunnels. Conclusion: Placement of the femoral tunnel over the medial femoral condyle by the palpatory method is accurate in close to 2/3rd of the cases only whereas rest 1/3rd may fall outside the acceptable position. Hence, it is recommended to confirm the placement of femoral tunnel with intraoperative fluoroscopy at the acceptable position to avoid error. Level of study: Retrospective case series, level IV.

Original languageEnglish
Pages (from-to)117-122
Number of pages6
JournalJournal of Arthroscopy and Joint Surgery
Volume6
Issue number2
DOIs
Publication statusPublished - 01-05-2019

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Palpation
Ligaments
Thigh
Patellar Dislocation
Fluoroscopy
Retrospective Studies
Femur
Transplants
Bone and Bones

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

@article{68f613d08dd24d41b15bf5ac2c5f9eb5,
title = "Accuracy of Schottle's point location by palpation and its role in clinical outcome after medial patellofemoral ligament reconstruction",
abstract = "Introduction: Medial patellofemoral ligament (MPFL) reconstruction is performed for the recurrent patellar dislocation (RPD). The crux of sound clinical results depends upon accurate placement of the graft at or within the 7-mm circle of Schottle point (acceptable position) over the femur. Most studies recommend the location of Schottle's point using intraoperative fluoroscopy or seldom by clinical palpation. We conducted a clinical study to understand the accuracy of locating Schottle's point by clinical palpation and its effect on outcome after MPFL reconstruction. Method: 30 patients with RPD were included in this retrospective study after MPFL reconstruction. Post-operative CTscan was performed to locate the position of the femoral tunnel using Servien grid criteria and Schottle's point location. The clinical outcome was assessed using Lysholm and Kujala Scores at the end of a minimum of two years. Results: 30 patients (11 male, 19 female) with a mean age of 24.8 years (range, 16–45 years) were followed for a mean of 42 months (range, 24–96 months). Mean Kujala score improved from 53.8 to 91.5 (p = 0.0001), and Lysholm score improved from 59.0 to 93.3 (p = 0.0001) in all 30 patients. Post-operative CT assessment revealed 19 patients (63.3{\%}) had a tunnel in an acceptable position and 11 patients (36.7{\%}) in an unacceptable position. Eight of the eleven unacceptable tunnels were placed in the anteroposterior direction, and three in superior-inferior direction. However, there was no significant difference between the Lysholm and Kujala scores of patients with acceptable versus unacceptable tunnels. Conclusion: Placement of the femoral tunnel over the medial femoral condyle by the palpatory method is accurate in close to 2/3rd of the cases only whereas rest 1/3rd may fall outside the acceptable position. Hence, it is recommended to confirm the placement of femoral tunnel with intraoperative fluoroscopy at the acceptable position to avoid error. Level of study: Retrospective case series, level IV.",
author = "Vivek Pandey and Mannava, {Kiran Kumar} and Nivedita Zakhar and Bhavya Mody and Kiran Acharya",
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Accuracy of Schottle's point location by palpation and its role in clinical outcome after medial patellofemoral ligament reconstruction. / Pandey, Vivek; Mannava, Kiran Kumar; Zakhar, Nivedita; Mody, Bhavya; Acharya, Kiran.

In: Journal of Arthroscopy and Joint Surgery, Vol. 6, No. 2, 01.05.2019, p. 117-122.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Accuracy of Schottle's point location by palpation and its role in clinical outcome after medial patellofemoral ligament reconstruction

AU - Pandey, Vivek

AU - Mannava, Kiran Kumar

AU - Zakhar, Nivedita

AU - Mody, Bhavya

AU - Acharya, Kiran

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Introduction: Medial patellofemoral ligament (MPFL) reconstruction is performed for the recurrent patellar dislocation (RPD). The crux of sound clinical results depends upon accurate placement of the graft at or within the 7-mm circle of Schottle point (acceptable position) over the femur. Most studies recommend the location of Schottle's point using intraoperative fluoroscopy or seldom by clinical palpation. We conducted a clinical study to understand the accuracy of locating Schottle's point by clinical palpation and its effect on outcome after MPFL reconstruction. Method: 30 patients with RPD were included in this retrospective study after MPFL reconstruction. Post-operative CTscan was performed to locate the position of the femoral tunnel using Servien grid criteria and Schottle's point location. The clinical outcome was assessed using Lysholm and Kujala Scores at the end of a minimum of two years. Results: 30 patients (11 male, 19 female) with a mean age of 24.8 years (range, 16–45 years) were followed for a mean of 42 months (range, 24–96 months). Mean Kujala score improved from 53.8 to 91.5 (p = 0.0001), and Lysholm score improved from 59.0 to 93.3 (p = 0.0001) in all 30 patients. Post-operative CT assessment revealed 19 patients (63.3%) had a tunnel in an acceptable position and 11 patients (36.7%) in an unacceptable position. Eight of the eleven unacceptable tunnels were placed in the anteroposterior direction, and three in superior-inferior direction. However, there was no significant difference between the Lysholm and Kujala scores of patients with acceptable versus unacceptable tunnels. Conclusion: Placement of the femoral tunnel over the medial femoral condyle by the palpatory method is accurate in close to 2/3rd of the cases only whereas rest 1/3rd may fall outside the acceptable position. Hence, it is recommended to confirm the placement of femoral tunnel with intraoperative fluoroscopy at the acceptable position to avoid error. Level of study: Retrospective case series, level IV.

AB - Introduction: Medial patellofemoral ligament (MPFL) reconstruction is performed for the recurrent patellar dislocation (RPD). The crux of sound clinical results depends upon accurate placement of the graft at or within the 7-mm circle of Schottle point (acceptable position) over the femur. Most studies recommend the location of Schottle's point using intraoperative fluoroscopy or seldom by clinical palpation. We conducted a clinical study to understand the accuracy of locating Schottle's point by clinical palpation and its effect on outcome after MPFL reconstruction. Method: 30 patients with RPD were included in this retrospective study after MPFL reconstruction. Post-operative CTscan was performed to locate the position of the femoral tunnel using Servien grid criteria and Schottle's point location. The clinical outcome was assessed using Lysholm and Kujala Scores at the end of a minimum of two years. Results: 30 patients (11 male, 19 female) with a mean age of 24.8 years (range, 16–45 years) were followed for a mean of 42 months (range, 24–96 months). Mean Kujala score improved from 53.8 to 91.5 (p = 0.0001), and Lysholm score improved from 59.0 to 93.3 (p = 0.0001) in all 30 patients. Post-operative CT assessment revealed 19 patients (63.3%) had a tunnel in an acceptable position and 11 patients (36.7%) in an unacceptable position. Eight of the eleven unacceptable tunnels were placed in the anteroposterior direction, and three in superior-inferior direction. However, there was no significant difference between the Lysholm and Kujala scores of patients with acceptable versus unacceptable tunnels. Conclusion: Placement of the femoral tunnel over the medial femoral condyle by the palpatory method is accurate in close to 2/3rd of the cases only whereas rest 1/3rd may fall outside the acceptable position. Hence, it is recommended to confirm the placement of femoral tunnel with intraoperative fluoroscopy at the acceptable position to avoid error. Level of study: Retrospective case series, level IV.

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