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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 19, Issue 12, pp 2067–2071 | Cite as

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

  • M. NelitzEmail author
  • D. Dornacher
  • J. Dreyhaupt
  • H. Reichel
  • S. Lippacher
Knee

Abstract

Purpose

The purpose of this study was to analyse true lateral radiographs of children and adolescents to determine the relation of the origin of the MPFL and the distal femoral physis considering the complex anatomy of the physis. The hypothesis was that the femoral insertion of the MPFL is distal to the growth plate.

Methods

Antero-posterior and true lateral radiographs from PACS computer records of 27 patients with a history of patellofemoral instability were assessed. To determine the femoral origin of the MPFL, the method by Schöttle et al. and the method by Redfern et al. were applied independently. On the anteroposterior radiograph, the distance between the medial most part of the physis and the central part of the physis was measured to quantify the concave curvature of the physis. To cross-reference the femoral insertion of the MPFL onto an ap view, the projected MPFL origin–physis distance was subtracted from the distance between the most medial part of the physis and the central part of the physis.

Results

The projected median origin of the MPFL as measured on a lateral radiograph was located 3.2 mm (1.2–5.8 mm) proximal to the physis. The median distance between the most medial part of the physis and the physeal line on the anteroposterior radiograph was 9.9 mm (4.1–12.0 mm). Subtracting the two measured values, the median origin of the MPFL as seen on the ap view was 6.4 mm (2.9–8.5 mm) distal to the femoral physis.

Conclusion

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.

Levels of evidence

Diagnostic study, Level II.

Keywords

MPFL Femoral insertion Open physis Patellofemoral instability 

References

  1. 1.
    Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220PubMedCrossRefGoogle Scholar
  2. 2.
    Baldwin JL (2009) The anatomy of the medial patellofemoral ligament. Am J Sports Med 37:2355–2361PubMedCrossRefGoogle Scholar
  3. 3.
    Bicos J, Fulkerson JP, Amis A (2007) Current concepts review: the medial patellofemoral ligament. Am J Sports Med 35:484–492PubMedCrossRefGoogle Scholar
  4. 4.
    Brown GD, Ahmad CS (2008) Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in skeletally immature patients. J Knee Surg 21:328–332PubMedGoogle Scholar
  5. 5.
    Camp CL, Krych AJ, Dahm DL, Levy BA, Stuart MJ (2010) Medial patellofemoral ligament repair for recurrent patellar dislocation. Am J Sports Med 38:2248–2254PubMedCrossRefGoogle Scholar
  6. 6.
    Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762PubMedCrossRefGoogle Scholar
  7. 7.
    Craig JG, Cody DD, Van Holsbeeck M (2004) The distal femoral and proximal tibial growth plates: MR imaging, three-dimensional modeling and estimation of area and volume. Skeletal Radiol 33:337–340PubMedCrossRefGoogle Scholar
  8. 8.
    Deie M, Ochi M, Sumen Y, Yasumoto M, Kobayashi K, Kimura H (2003) Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg Br 85:887–890PubMedGoogle Scholar
  9. 9.
    Duri ZA, Patel DV, Aichroth PM (2002) The immature athlete. Clin Sports Med 21:461–468PubMedCrossRefGoogle Scholar
  10. 10.
    Elias JJ, Cosgarea AJ (2006) Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 34:1478–1485PubMedCrossRefGoogle Scholar
  11. 11.
    Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW (2011) Zone of injury of the medial patello-femoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med [epub ahead of print]Google Scholar
  12. 12.
    Ladd PE, Laor T, Emery KH, Salisbury SR, Parikh SN (2010) Medial collateral ligament of the knee on magnetic resonance imaging: does the site of the femoral origin change at different patient ages in children and young adults? J Pediatr Orthop 30:224–230PubMedCrossRefGoogle Scholar
  13. 13.
    LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89:2000–2010PubMedCrossRefGoogle Scholar
  14. 14.
    Melegari TM, Parks BG, Matthews LS (2008) Patellofemoral contact area and pressure after medial patellofemoral ligament reconstruction. Am J Sports Med 36:747–752PubMedCrossRefGoogle Scholar
  15. 15.
    Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7:121–127PubMedCrossRefGoogle Scholar
  16. 16.
    Redfern J, Kamath G, Burks R (2010) Anatomical confirmation of the use of radiographic landmarks in medial patellofemoral ligament reconstruction. Am J Sports Med 38:293–297PubMedCrossRefGoogle Scholar
  17. 17.
    Schoettle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35:801–804CrossRefGoogle Scholar
  18. 18.
    Shea KG, Grimm NL, Belzer J, Burks RT, Pfeiffer R (2010) The relation of the femoral physis and the medial patellofemoral ligament. Arthroscopy 26:1083–1087PubMedCrossRefGoogle Scholar
  19. 19.
    Sillanpää PJ, Mäenpää HM, Arendt EA (2010) Treatment of lateral patella dislocation in the skeletally immature athlete. Oper Tech Sports Med 18:83–92CrossRefGoogle Scholar
  20. 20.
    Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10:221–227PubMedCrossRefGoogle Scholar
  21. 21.
    Steensen RN, Dopirak RM, McDonald WG (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32:1509–1513PubMedCrossRefGoogle Scholar
  22. 22.
    Stein Shubin BE, Ahmad CS (2007) The management of patellar instability in the skeletally immature patient. Oper Tech Orthop 17:250–256CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • M. Nelitz
    • 1
    Email author
  • D. Dornacher
    • 1
  • J. Dreyhaupt
    • 2
  • H. Reichel
    • 1
  • S. Lippacher
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of UlmUlmGermany
  2. 2.Institute of Epidemiology and Medical BiometryUniversity of UlmUlmGermany

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