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Purpose <p>Restoration of medial soft-tissue restraint is essential in the surgical treatment of lateral patellofemoral instability. While anatomic medial patellofemoral ligament reconstruction (MPFLR) has become the preferred technique, non-anatomic procedures such as vastus medialis advancement (VMA) are still used in selected clinical scenarios. However, controlled biomechanical data comparing these techniques remain limited. This study aimed to evaluate and compare the tensile behavior of VMA and MPFL reconstruction using a cadaveric biomechanical model.</p> Methods <p>Ten fresh-frozen human cadaveric knees were mounted in a custom-designed biomechanical testing apparatus that simulated physiological quadriceps loading. Progressive lateral force was applied to reproduce patellar dislocation, and the failure load of the native medial patellofemoral ligament was recorded. Specimens were then randomized into two groups: MPFL reconstruction (<i>n</i> = 5) and vastus medialis advancement (<i>n</i> = 5). Tensile testing was repeated following each procedure, and the forces required to produce 10, 20, 30 and 40&#xa0;mm of lateral patellar displacement were measured and analyzed.</p> Results <p>Following reconstruction, the MPFLR group demonstrated numerically higher tensile force values at 10, 20, and 30&#xa0;mm of lateral patellar displacement compared with the native condition, whereas the VMA group exhibited lower tensile force values across this physiologically relevant displacement range. At 40&#xa0;mm displacement, which exceeds physiological patellar translation and reflects failure behavior rather than functional stability, a reduction in tensile force was observed in both groups. Overall, mean tensile force values tended to be higher in the MPFLR group than in the VMA group; however, no statistically significant differences were observed between the two techniques in either the medial soft-tissue injury induction test or the post-reconstruction tensile rupture test (<i>p</i> &gt; 0.05 for all comparisons).</p> Conclusion <p>In this cadaveric biomechanical study, medial patellofemoral ligament reconstruction and vastus medialis advancement demonstrated different construct behavior patterns, with no statistically significant differences in the tensile force required to achieve lateral patellar displacement.</p>

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Comparative cadaveric biomechanical analysis of vastus medialis advancement and medial patellofemoral ligament reconstruction

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月17日

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  • Cihad Çağrı Üstün,
  • Semih Aydoğdu,
  • Elçil Kaya Biçer,
  • Buğra Hüsemoğlu,
  • Abdullah Faruk Uyanık

摘要

Purpose

Restoration of medial soft-tissue restraint is essential in the surgical treatment of lateral patellofemoral instability. While anatomic medial patellofemoral ligament reconstruction (MPFLR) has become the preferred technique, non-anatomic procedures such as vastus medialis advancement (VMA) are still used in selected clinical scenarios. However, controlled biomechanical data comparing these techniques remain limited. This study aimed to evaluate and compare the tensile behavior of VMA and MPFL reconstruction using a cadaveric biomechanical model.

Methods

Ten fresh-frozen human cadaveric knees were mounted in a custom-designed biomechanical testing apparatus that simulated physiological quadriceps loading. Progressive lateral force was applied to reproduce patellar dislocation, and the failure load of the native medial patellofemoral ligament was recorded. Specimens were then randomized into two groups: MPFL reconstruction (n = 5) and vastus medialis advancement (n = 5). Tensile testing was repeated following each procedure, and the forces required to produce 10, 20, 30 and 40 mm of lateral patellar displacement were measured and analyzed.

Results

Following reconstruction, the MPFLR group demonstrated numerically higher tensile force values at 10, 20, and 30 mm of lateral patellar displacement compared with the native condition, whereas the VMA group exhibited lower tensile force values across this physiologically relevant displacement range. At 40 mm displacement, which exceeds physiological patellar translation and reflects failure behavior rather than functional stability, a reduction in tensile force was observed in both groups. Overall, mean tensile force values tended to be higher in the MPFLR group than in the VMA group; however, no statistically significant differences were observed between the two techniques in either the medial soft-tissue injury induction test or the post-reconstruction tensile rupture test (p > 0.05 for all comparisons).

Conclusion

In this cadaveric biomechanical study, medial patellofemoral ligament reconstruction and vastus medialis advancement demonstrated different construct behavior patterns, with no statistically significant differences in the tensile force required to achieve lateral patellar displacement.