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Medial patellofemoral ligament MRI abnormalities in the setting of MCL injuries: are they clinically relevant?

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Abstract

Objective

To assess MRI abnormalities of the medial patellofemoral ligament (MPFL) in patients with clinically and MRI-proven superficial medial collateral ligament (sMCL) injuries and determine the clinical significance.

Materials and methods

High-field strength knee MRI examinations were selected which demonstrated sMCL injuries. These cases were retrospectively reviewed for the presence, location, and severity of MPFL abnormality. The MPFL was divided into a more superior transverse component arising from a femoral attachment (tMPFL), and a broader more inferior oblique decussation component (odMPFL) arising from the anterior margin of the upper sMCL. Chart review was performed to determine the clinical relevance of any MPFL findings.

Results

One hundred patients with MCL injury were identified. These included 37 grade I sprains, 33 partial tears, 20 high-grade partial tears, and 10 full thickness tears. Abnormal edema was present at the femoral attachment of the tMPFL in 83%. The odMPFL was abnormal in 90%, most commonly involving the femoral third. No patients had imaging evidence of concurrent lateral patellar dislocation on the initial MRI study. No patients had documented patellofemoral instability at the time of original injury or upon follow-up. No patients required MPFL reconstruction.

Conclusion

The MRI appearance of the MPFL is abnormal in the majority of patients with clinically and MRI-documented sMCL sprains and tears. These cases had no evidence of concurrent lateral patellar dislocation on the initial MRI and did not develop patellar instability symptoms.

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Abbreviations

AMT:

Adductor magnus tendon

AT:

Adductor tubercle

dMCL:

Deep medial collateral ligament

fsT2W:

Fat suppressed T2 weighted

MCL:

Medial collateral ligament

MPFL:

Medial patellofemoral ligament

odMPFL:

Oblique decussation component of the MPFL

PDW:

Proton density weighted

sMCL:

Superficial medial collateral ligament

tMPFL:

Transverse component of the upper MPFL

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Acknowledgements

The authors acknowledge Michael J. Stuart MD, Department of Orthopedics and Sports Medicine, for critical review of the manuscript, and Sonia Watson PhD for assistance in preparation of the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Mark S. Collins, Christin A. Tiegs-Heiden & Matthew A. Frick

  2. Mayo Clinic Alix School of Medicine, Rochester, MN, USA

    Michael D. Brandt

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  1. Mark S. Collins
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  2. Christin A. Tiegs-Heiden
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  3. Matthew A. Frick
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Correspondence to Mark S. Collins.

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Approval from the Institutional Review Board was obtained and in keeping with the policies for a retrospective review; informed consent was not required.

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The authors declare no competing interests.

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Collins, M.S., Tiegs-Heiden, C.A., Frick, M.A. et al. Medial patellofemoral ligament MRI abnormalities in the setting of MCL injuries: are they clinically relevant?. Skeletal Radiol 51, 1381–1389 (2022). https://doi.org/10.1007/s00256-021-03969-4

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  • DOI: https://doi.org/10.1007/s00256-021-03969-4

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