Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy

Abstract

PurposeThe medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the medial patella. The exact position reported in the literature varies. Understanding the true anatomical origin and insertion of the MPFL is critical to successful reconstruction. The purpose of this systematic review was to determine these locations.MethodsA systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016. All papers investigating the anatomy of the MPFL were eligible. Methodological quality was assessed using a modified CASP tool. A narrative analysis approach was adopted to synthesise the findings.ResultsAfter screening and review of 2045 papers, a total of 67 studies investigating the relevant anatomy were included. From this, the origin appears to be from an area rather than (as previously reported) a single point on the medial femoral condyle. The weighted average length was 56 mm with an ‘hourglass’ shape, fanning out at both ligament ends.ConclusionThe MPFL is an hourglass-shaped structure running from a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. Awareness of anatomy is critical for assessment, anatomical repair and successful surgical patellar stabilisation.Level of evidenceSystematic review of anatomical dissections and imaging studies, Level IV.

Computational approach to correcting joint instability in patients with recurrent patellar dislocation

“…Native MPFL properties also serve to represent a true “restorative” procedure by restoring the properties of the MPFL to its pre‐injury state. The MPFL femoral insertion area covers a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle .…”

“…The MPFL femoral insertion area covers a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle. 42 As a non-anatomical reconstruction of the MPFL can lead to non-physiological PF loads and kinematics, the MPFL femoral insertion anatomy chosen was within the boundary of the medial epicondyle. 43 The MPFL was initially tensioned such that the tension was minimal across passive flexion from 5°to 70°.…”

Management of Injuries to the Medial Patellofemoral Ligament: A Review

“…Previously, it was widely accepted that the lateral portion of the MPFL had a broad attachment onto the proximal medial portion of the patella over a 20-to 30-mm-wide area. 20 However, a recent cadaveric study of 28 knees by Tanaka 21 found that MPFL insertion onto the patellar demonstrated considerable variability. In the 28 knees that were analyzed, the mean percentage of MPFL fibers that inserted onto the patella was 57.3 AE 19.5% (range: 0-100%; 95% confidence interval [CI]: 50.1-64.5).…”

Patellar Dislocation in a Patient with Kabuki Syndrome with Severe Mental Retardation: A Case Report

“…2). 6,7) Manual reduction was tried when the patient was awake. The patella reduced but dislocated immediately following reduction.…”