Advertisement

Surgical and Radiologic Anatomy

, Volume 36, Issue 8, pp 733–739 | Cite as

Anatomical study of the medial patello-femoral ligament: landmarks for its surgical reconstruction

  • Anthony Viste
  • Florian Chatelet
  • Romain Desmarchelier
  • Michel-Henri Fessy
Original Article

Abstract

Purpose

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.

Methods

Twelve knees (7 cadavers) were included for the study. Measurements and general features of the MPFL were assessed: lengths, widths and insertions.

Results

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.

Conclusion

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).

Keywords

Medial patello-femoral ligament (MPFL) Patellar dislocation Reconstruction Ligamentous knee 

Notes

Conflict of interest

None.

References

  1. 1.
    Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220PubMedCrossRefGoogle Scholar
  2. 2.
    Aragao JA, Reis FP, de Vasconcelos DP, Feitosa VL, Nunes MA (2008) Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadavers. Clinics (Sao Paulo) 63(4):541–544CrossRefGoogle Scholar
  3. 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
  4. 4.
    Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65PubMedGoogle Scholar
  5. 5.
    Dirim B, Haghighi P, Trudell D, Portes G, Resnick D (2008) Medial patellofemoral ligament: cadaveric investigation of anatomy with MRI, MR arthrography, and histologic correlation. AJR 191(2):490–498. doi: 10.2214/AJR.07.3590 PubMedCrossRefGoogle Scholar
  6. 6.
    Ebied AM, El-Kholy W (2012) Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability. Knee Surg Sports Traumatol Arthrosc 20(5):926–932. doi: 10.1007/s00167-011-1659-x PubMedCrossRefGoogle Scholar
  7. 7.
    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(9):1478–1485. doi: 10.1177/0363546506287486 PubMedCrossRefGoogle Scholar
  8. 8.
    Feller JA, Feagin JA Jr, Garrett WE Jr (1993) The medial patellofemoral ligament revisited: an anatomical study. Knee Surg Sports Traumatol Arthrosc 1(3–4):184–186PubMedCrossRefGoogle Scholar
  9. 9.
    Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 349:174–182PubMedCrossRefGoogle Scholar
  10. 10.
    Kang HJ, Wang F, Chen BC, Su YL, Zhang ZC, Yan CB (2010) Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 18(11):1511–1516. doi: 10.1007/s00167-010-1090-8 PubMedCrossRefGoogle Scholar
  11. 11.
    Kaplan EB (1957) Factors responsible for the stability of the knee joint. Bull Hosp Jt Dis 18(1):51–59Google Scholar
  12. 12.
    LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Jt Surg Am 89(9):2000–2010. doi: 10.2106/JBJS.F.01176 CrossRefGoogle Scholar
  13. 13.
    Lind M, Jakobsen BW, Lund B, Christiansen SE (2008) Reconstruction of the medial patellofemoral ligament for treatment of patellar instability. Acta Orthop 79(3):354–360. doi: 10.1080/17453670710015256 PubMedCrossRefGoogle Scholar
  14. 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
  15. 15.
    Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23(5):260–263PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Nomura E, Horiuchi Y, Inoue M (2002) Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee 9(2):139–143PubMedCrossRefGoogle Scholar
  17. 17.
    Nomura E, Inoue M, Osada N (2005) Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 13(7):510–515. doi: 10.1007/s00167-004-0607-4 PubMedCrossRefGoogle Scholar
  18. 18.
    Philippot R, Chouteau J, Wegrzyn J, Testa R, Fessy MH, Moyen B (2009) Medial patellofemoral ligament anatomy: implications for its surgical reconstruction. Knee Surg Sports Traumatol Arthrosc 17(5):475–479. doi: 10.1007/s00167-009-0722-3 PubMedCrossRefGoogle Scholar
  19. 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
  20. 20.
    Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24(1):52–60PubMedCrossRefGoogle Scholar
  21. 21.
    Schottle PB, Hensler D, Imhoff AB (2010) Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc 18(2):147–151. doi: 10.1007/s00167-009-0868-z PubMedCrossRefGoogle Scholar
  22. 22.
    Schottle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35(5):801–804. doi: 10.1177/0363546506296415 PubMedCrossRefGoogle Scholar
  23. 23.
    Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10(3):221–227PubMedCrossRefGoogle Scholar
  24. 24.
    Smith TO, Song F, Donell ST, Hing CB (2011) Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 19(6):988–998. doi: 10.1007/s00167-010-1355-2 PubMedCrossRefGoogle Scholar
  25. 25.
    Steensen RN, Dopirak RM, McDonald WG 3rd (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32(6):1509–1513. doi: 10.1177/0363546503261505 PubMedCrossRefGoogle Scholar
  26. 26.
    Tuxoe JI, Teir M, Winge S, Nielsen PL (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10(3):138–140. doi: 10.1007/s00167-001-0261-z PubMedCrossRefGoogle Scholar
  27. 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
  28. 28.
    Wijdicks CA, Griffith CJ, LaPrade RF, Johansen S, Sunderland A, Arendt EA, Engebretsen L (2009) Radiographic identification of the primary medial knee structures. J Bone Jt Surg Am 91(3):521–529. doi: 10.2106/JBJS.H.00909 CrossRefGoogle Scholar
  29. 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

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Anthony Viste
    • 1
    • 2
    • 3
    • 4
  • Florian Chatelet
    • 1
  • Romain Desmarchelier
    • 2
  • Michel-Henri Fessy
    • 1
    • 2
    • 3
    • 4
  1. 1.Faculté de Médecine Lyon Sud-Charles Mérieux, Laboratoire d’AnatomieOullins CedexFrance
  2. 2.Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique, Traumatologique et Médecine du SportPierre Bénite, CedexFrance
  3. 3.Université de LyonLyonFrance
  4. 4.IFSTTAR, UMRT_9406, LBMC, Université Lyon1VilleurbanneFrance

Personalised recommendations