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CiOS Clinics in Orthopedic Surgery, cilt.18, sa.3, ss.461-473, 2026 (SCI-Expanded, Scopus)
Background: The objective of this experimental study was to assess the accuracy of the Schöttle technique in localizing the femoral footprint of the medial patellofemoral ligament (MPFL) in femora with and without trochlear dysplasia, utilizing 3-dimensional (3D)-printed bone models and standardized fluoroscopic imaging. It was hypothesized that trochlear dysplasia, particularly in its more severe forms, would negatively influence the accuracy of this radiographic method. Methods: A total of forty-four 3D-printed femoral models, generated from computed tomography scans of patients with trochlear dysplasia (n = 21) and those with normal trochlear morphology (n = 23), were included in the analysis. The anatomic MPFL insertion was defined using the saddle sulcus and marked with a radiopaque reference. True lateral knee fluoroscopic images were obtained, and the Schöttle point was identified using standard radiographic criteria. The distance between the Schöttle point and the anatomic footprint was measured. Deviations > 5 mm and > 7 mm were defined as clinically unacceptable. Subgroup analysis was performed according to Dejour classification. Results: The mean distance between the Schöttle point and the anatomic footprint was 4.4 ± 2.0 mm in the dysplasia group and 4.2 ± 2.4 mm in the control group (p = 0.862). The proportion of clinically acceptable placements did not differ significantly at the 5 mm (66.7% vs. 60.9%, p = 0.467) or 7 mm (85.7% vs. 82.6%, p = 0.553) thresholds. Accuracy was also similar across dysplasia grades (p = 0.477). Conclusions: In this experimental modeling study, the Schöttle technique demonstrated similar average accuracy in localizing the femoral MPFL footprint in femora with and without trochlear dysplasia. However, clinically relevant deviations greater than 5 mm were observed in approximately one-third of cases, regardless of trochlear morphology. The Schöttle technique may serve as an intraoperative estimate rather than a definitive target, pending in-vivo validation. Surgeons should be cautious and consider complementary methods to optimize femoral tunnel placement.