Skip to main content
Log in

The role of the medial ligamentous structures on patellar tracking during knee flexion

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope



The influence of the medial patellar ligamentous structures on patellar tracking has rarely been studied. Thus the main purpose of this cadaveric biomechanical study was to determine the influence of the medial patellofemoral (MPFL), medial patellomeniscal (MPML) and medial patellotibial (MPTL) ligaments on the three-dimensional patellar tracking during knee flexion. This study was conducted using a validated cadaveric optoelectronic protocol for analysis of patellar kinematics.


For each cadaveric knee study, four successive acquisitions were performed; first was studied patellar tracking in healthy knees, then the junction between MPFL and vastus medialis obliquus (VMO) was sectioned, the MPFL was released at its patellar attachment and finally was released the insertion of the MPML and MPTL.


In this study, the MPFL accounts for 50–60% of the medial stabilization forces of the lateral patellar shift during patellar engagement in the femoral trochlea. This work confirm and clarify the role of the MPFL as the primary stabilizer of the patella during the initial 30° of knee flexion. Moreover, this study shows no significant results regarding the stabilizing action of the VMO on the patella during knee flexion.


This in vitro study, conducted with an experimental protocol previously validated in the literature, helps quantify the actions of the MPFL, the VMO, and the MPML/MPTL respectively, and identify areas of joint motion where these structures have the most significant influence. This confirms the importance of reconstruction in the treatment of chronic patellar instability. During its reconstruction, care should be taken to adjust the MPFL balance during the initial 20°–30° of flexion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220

    Article  PubMed  CAS  Google Scholar 

  2. Arendt EA, Fithian DC, Cohen E (2002) Current concepts of lateral patella dislocation. Clin Sports Med 21:499–519

    Article  PubMed  Google Scholar 

  3. Bull AM, Katchburian MV, Shih YF, Amis AA (2002) Standardisation of the description of patellofemoral motion and comparison between different techniques. Knee Surg Sports Traumatol Arthrosc 10:184–193

    Article  PubMed  CAS  Google Scholar 

  4. Conlan T, Garth WP, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693

    PubMed  CAS  Google Scholar 

  5. Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65

    PubMed  CAS  Google Scholar 

  6. Drez D, Edwards TB, Williams CS (2001) Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation. Arthroscopy 17:298–306

    Article  PubMed  Google Scholar 

  7. Goh JC, Lee PY, Bose K (1995) A cadaver study of the function of the oblique part of vastus medialis. J Bone Joint Surg Br 77:225–231

    PubMed  CAS  Google Scholar 

  8. Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105:136–144

    Article  PubMed  CAS  Google Scholar 

  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 349:174–182

    Article  PubMed  Google Scholar 

  10. Heegaard J, Leyvraz PF, Curnier A, Rakotomanana L, Huiskes R (1995) The biomechanics of the human patella during passive knee flexion. J Biomech 28:1265–1279

    Article  PubMed  CAS  Google Scholar 

  11. Henry JH, Craven PR (1981) Surgical treatment of patellar instability: indications and results. Am J Sports Med 9:82–85

    Article  PubMed  CAS  Google Scholar 

  12. Katchburian MV, Bull AM, Shih YF, Heatley FW, Amis AA (2003) Measurement of patellar tracking: assessment and analysis of the literature. Clin Orthop Relat Res 412:241–259

    Article  PubMed  Google Scholar 

  13. Nakagawa K, Wada Y, Minamide M, Tsuchiya A, Moriya H (2002) Deterioration of long term clinical results after the Elmslie–Trillat procedure for dislocation of the patella. J Bone Joint Surg Br 84:861–864

    Article  PubMed  CAS  Google Scholar 

  14. Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 14:7–12

    Article  PubMed  Google Scholar 

  15. Philippot R, Chouteau J, Testa R, Moyen B (2010) In vitro analysis of patellar kinematics: validation of an opto-electronic cinematic analysis protocol. Knee Surg Sports Traumatol Arthrosc 18:161–166

    Article  PubMed  Google Scholar 

  16. Raimondo RA, Ahmad CS, Blankevoort LB (1998) Patellar stabilization: a quantitative evaluation of the vastus medialis obliquus muscle. Orthopedics 21:791–795

    PubMed  CAS  Google Scholar 

  17. Reider B, Marshall JL, Ring B (1981) Patellar tracking. Clin Orthop Relat Res 157:143–148

    PubMed  Google Scholar 

  18. Yamada Y, Toritsuka Y, Horibe S, Sugamoto K, Yoshikawa H, Shino K (2007) In vivo movement analysis of the patella using a three-dimensional computer model. J Bone Joint Surg Br 89(6):752–760

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to R. Philippot.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Philippot, R., Boyer, B., Testa, R. et al. The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc 20, 331–336 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: