The relation of the distal femoral physis and the medial patellofemoral ligament

Abstract

Considering the concave curvature of the distal femoral physis, it can be assumed that the femoral insertion of the MPFL is distal to the femoral physis. As a too proximal insertion of the graft can cause unintentional tightening of the MPFL in knee flexion, these results have to be considered when performing reconstruction of the MPFL in children and adolescents with open growth plates.

Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents Using a Pedicled Quadriceps Tendon Graft

“…Conversely, other authors have shown that the insertion of the MPFL is typically between 5 mm and 6.4 mm distal to the femoral physis. 8,12 Thus there is enough room for secure and safe placement of a suture anchor or tunnel in an anatomic location, as described in this report, without jeopardizing growth. 8,9 Whereas other authors have described the use of the quadriceps tendon in reconstruction of the MPFL, we believe that this report is the first to describe the use of Table 1.…”

“…Because of the concave curvature of the distal femoral physis, the lateral radiograph alone can be misleading for the determination of the relation between the distal femoral physis and the MPFL. 8 The cross reference onto an anteroposterior view shows that the same point that is projected on or proximal to the physis on the lateral view is distal to the physis on the anteroposterior view. 8 A guidewire is placed at the femoral insertion.…”

“…8 The cross reference onto an anteroposterior view shows that the same point that is projected on or proximal to the physis on the lateral view is distal to the physis on the anteroposterior view. 8 A guidewire is placed at the femoral insertion. After verification of the entry point in both the anteroposterior and true lateral planes, the guide pin is drilled to the lateral condyle.…”

Medial Patellofemoral Ligament Reconstruction Using Hamstring Autograft in Children and Adolescents

“…Bone fixation proximal to the distal femoral physis may result in proximal migration of the femoral insertion of the MPFL, causing excessive graft tension, loss of graft isometry, and loss of knee motion. 10 Therefore our preferred method is to dock the 2 ends of the graft in the superior-medial patella using partial socket tunnels and to place the femoral socket tunnel distal to the physis.…”

Rekonstruktion des medialen patellofemoralen Ligaments mit autologer Grazilissehne in patellarseitig implantatfreier Technik

“…Letztere liegt in enger anatomischer Beziehung zur Epiphysenfuge, so dass hier Verletzungen mit konsekutiven Wachstumsstörungen möglich sind. In radiologischen Studien konnte gezeigt werden, dass sich die femorale MPFL-Insertion etwa 6,4 mm distal der Wachstumsfuge befindet [17]. Um diese nicht zu verletzen, wurden nichtanatomische Verfahren, z.…”