Anatomical study of the medial patello-femoral ligament: landmarks for its surgical reconstruction
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The aim of this dissection study was to describe the anatomical insertions of the medial patello-femoral ligament (MPFL), and to assess its relationship with surrounding structures to improve its surgical reconstruction.
Twelve knees (7 cadavers) were included for the study. Measurements and general features of the MPFL were assessed: lengths, widths and insertions.
The MPFL was found in all knees, presenting a triangular shape, and extending from the medial part of the patella to its femoral insertion (its length was of 59 ± 6.6 mm), distal to the adductor tubercle. The mean femoral insertion of the MPFL was 7.2 ± 2.7 mm proximal and 7.4 ± 4.0 mm posterior to the medial femoral epicondyle (MFE). It was also at a mean 11 ± 2.8 mm distal and 1.3 ± 2.1 mm posterior to the adductor tubercle, and 22 ± 6.4 mm anterior to the posterior condyle. We did not find any double-bundle organization on the patellar insertion. The width of the MPFL was 8.8 ± 2.9 mm at the femoral insertion, 27 ± 5.9 mm at the patellar insertion, and 12 ± 3.1 mm in the middle of the MPFL. The vastus medialis obliquus was found to be inserted on the superior part of the MPFL.
The adductor tubercle appeared to be a better landmark than the MFE for the femoral tunnel positioning during surgical reconstructions of the MPFL because it was easier to identify and its relationship with the femoral insertion of the MPFL was constant (10 mm below).
KeywordsMedial patello-femoral ligament (MPFL) Patellar dislocation Reconstruction Ligamentous knee
Conflict of interest
- 3.Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Jt Surg Am 75(5):682–693Google Scholar
- 11.Kaplan EB (1957) Factors responsible for the stability of the knee joint. Bull Hosp Jt Dis 18(1):51–59Google Scholar
- 14.Mochizuki T, Nimura A, Tateishi T, Yamaguchi K, Muneta T, Akita K (2013) Anatomic study of the attachment of the medial patellofemoral ligament and its characteristic relationships to the vastus intermedius. Knee Surg Sports Traumatol Arthrosc 21(2):305–310. doi: 10.1007/s00167-012-1993-7 PubMedCrossRefGoogle Scholar
- 19.Reider B, Marshall JL, Koslin B, Ring B, Girgis FG (1981) The anterior aspect of the knee joint. J Bone Jt Surg Am 63(3):351–356Google Scholar
- 27.Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Jt Surg Am 61(1):56–62Google Scholar
- 29.Zaffagnini S, Colle F, Lopomo N, Sharma B, Bignozzi S, Dejour D, Marcacci M (2012) The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-012-2307-9