Quantitative and Qualitative Analysis of the Medial Patellar Ligaments: An Anatomic and Radiographic Study

Abstract

The findings of this study provide the anatomic foundation needed for an improved understanding of the role of medial-sided patellar restraints. This will help to further refine injury patterns and/or soft tissue deficiencies that result in lateral patellar instability, which can then be addressed with an anatomic-based reconstruction or repair technique and potentially lead to improved outcomes.

Editorial Commentary: Medial Patellofemoral Ligament Reconstruction Alone Works Well When the Patient Has Normal Alignment, But Don't Forget to Move the Tibial Tubercle When Necessary!

“…Every graft, regardless of type, must be placed anatomically. Mochizuki et al, 6 Tanaka et al, 3 Krukeberg et al, 7 Hinckel et al, 8 and others have emphasized the complexity of the MPFC. Consistent accuracy of graft placement requires a rigorous understanding of medial patellofemoral anatomy.…”

Editorial Commentary: Medial Patellofemoral Complex: Driving a Better Understanding of Medial Knee Anatomy

“…52 Most of the studies in the last 2 years are in agreement that the MPFC attaches more proximally than we thought, having a connection to the medial border of the vastus intermedius tendon (Table 1). 40,41,[43][44][45]47,49,50 My colleagues and I performed a cadaveric dissection and found similar findings; that MPFC originates from a midpoint between the femoral epicondyle and adductor tubercle. It fans out into 2 bands: a main thick band to the upper half of the patella and a thin upper layer running anteriorly, upward, then under the vastus medialis obliquus.…”

Editorial Commentary: The “F” in MPFL (Medial Patellofemoral Ligament) Reconstruction—How Should We Fix It and Does It Matter?

“…9 Conversely, other surgeons have advocated for more extensive soft-tissue dissection to avoid tunnel malposition, preferably dissecting the native attachment in the saddle point between the adductor tendon and medial epicondyle. 10 Despite these approaches, many have expressed concerns about femoral socket morbidity and finding isometry with a single point of fixation on the femoral side, 11 particularly with patella alta. 12 Furthermore, with even subtle malposition of the attachment point or suboptimal lateral radiographic views, 13 rigid femoral tunnel fixation can result in overconstraint of the MPFL, limitations in knee flexion, or worse yet, advanced patellofemoral arthrosis or iatrogenic medial instability.…”