Skip to main content
SpringerLink
Log in

Medial Patellofemoral Ligament Reconstruction: Anatomical Versus Quasi-anatomical Femoral Fixation

  • Chapter
  • First Online:
Anterior Knee Pain and Patellar Instability

  • 566 Accesses

Abstract

Chronic lateral patellar instability (CLPI) is a common finding in the orthopedic knee surgeon´s daily clinical practice. First-time lateral patellar dislocation has an incidence rate of 23 per 100,000 person-year. (Sanders et al. in Sports Health. 10:146–151, 2018) After a first episode, patellar dislocation recurrence follows in more than 50% of patients. (Huntington et al. in Am J Sports Med 48:2552–2562, 2020).

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sanders TL, Pareek A, Hewett TE, et al. Incidence of first-time lateral patellar dislocation: a 21-year population-based study. Sports Health. 2018;10(2):146–51.

    Article  PubMed  Google Scholar 

  2. Huntington LS, Webster KE, Devitt BM, et al. Factors associated with an increased risk of recurrence after a first-time patellar dislocation: a systematic review and meta-analysis. Am J Sports Med. 2020;48(10):2552–62.

    Article  PubMed  Google Scholar 

  3. Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop. 1999;23(5):260–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Allen MM, Krych AJ, Johnson NR, et al. Combined tibial tubercle osteotomy and medial patellofemoral ligament reconstruction for recurrent lateral patellar instability in patients with multiple anatomic risk factors. Arthroscopy. 2018;34(8):2420–6.

    Article  PubMed  Google Scholar 

  5. Nelitz M, Dreyhaupt J, Robert S, et al. Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop. 2015;39(12):2355–62.

    Article  PubMed  Google Scholar 

  6. Nelitz M, Williams SR. [Combined trochleoplasty and medial patellofemoral ligament reconstruction for patellofemoral instability]. [Article in German] Oper Orthop Traumatol. 2015;27(6):495–504.

    Google Scholar 

  7. Ellera Gomes JL. Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy. 1992;8(3):335–40.

    Article  CAS  PubMed  Google Scholar 

  8. Avikainen VJ, Nikku RK, Seppanen-Lehmonen TK. Adductor magnus tenodesis for patellar dislocation. Technique and preliminary results. Clin Orthop Relat Re. 1993;(297):12–16.

    Google Scholar 

  9. Teitge RA. Treatment of complications of patellofemoral joint surgery. Oper Tech Sports Med. 1994;4:317–33.

    Google Scholar 

  10. Gallie WE, Lemesurier AB. Habitual dislocation of the patella. J Bone J Surg. 1924;6(3):575–82.

    Google Scholar 

  11. Monllau JC, Masferrer-Pino A, Ginovart G, et al. Clinical and radiological outcomes after a quasi-anatomical reconstruction of medial patellofemoral ligament with gracilis tendon autograft. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2453–9.

    Article  PubMed  Google Scholar 

  12. Seitlinger G, Moroder P, Fink C, et al. Acquired femoral flexion deformity due to physeal injury during medial patellofemoral ligament reconstruction. Knee. 2017;24(3):680–5.

    Article  PubMed  Google Scholar 

  13. Sanchis-Alfonso V. Guidelines for medial patellofemoral ligament reconstruction in chronic lateral patellar instability. J Am Acad Orthop Surg. 2014;22:175–82.

    Article  PubMed  Google Scholar 

  14. Sanchis-Alfonso V, Ramírez-Fuentes C, Montesinos-Berry E, et al. Femoral insertion site of the graft used to replace the medial patellofemoral ligament influences the ligament dynamic changes during knee flexion and the clinical outcome. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2433–41.

    Article  PubMed  Google Scholar 

  15. Wang C, Kernkamp WA, Li C, et al. Elongation and orientation pattern of the medial patellofemoral ligament during lunging. J Orthop Res. 2021;39(9):2036–47.

    Article  PubMed  Google Scholar 

  16. Pérez-Prieto D, Capurro B, Gelber PE, et al. The anatomy and isometry of a quasi-anatomical reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2420–3.

    Article  PubMed  Google Scholar 

  17. Schöttle PB, Schmeling A, Rosenstiel N, et al. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med. 2007;35(5):801–4.

    Article  PubMed  Google Scholar 

  18. Ziegler CG, Fulkerson JP, Edgar C. Radiographic reference points are inaccurate with and without a true lateral radiograph: The importance of anatomy in medial patellofemoral ligament reconstruction. Am J Sports Med. 2016;44(1):133–42.

    Article  PubMed  Google Scholar 

  19. Sanchis-Alfonso V, Ramirez-Fuentes C, Montesinos-Berry E, et al. Radiographic location does not ensure a precise anatomic location of the femoral fixation site in medial patellofemoral ligament reconstructions. Orthop J Sports Med.2017. https://doi.org/10.1177/2325967117739252.

  20. Chen J, Han K, Jiang J, et al. Radiographic reference points do not ensure anatomic femoral fixation sites in medial patellofemoral ligament reconstruction: a quantified anatomic localization method based on the saddle sulcus. Am J Sports Med. 2021;49(2):435–41.

    Article  PubMed  Google Scholar 

  21. Ishikawa M, Hoo C, Ishifuro M, et al. Application of a true lateral virtual radiograph from 3D-CT to identify the femoral reference point of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2021. https://doi.org/10.1007/s00167-020-06403-9.

    Article  PubMed  Google Scholar 

  22. Fujino K, Tajima G, Yan J, et al. Morphology of the femoral insertion site of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2015;23(4):998–1003.

    Article  PubMed  Google Scholar 

  23. Viste A, Chatelet F, Desmarchelier R, et al. Anatomical study of the medial patello-femoral ligament: landmarks for its surgical reconstruction. Surg Radiol Anat. 2014;36(8):733–9.

    Article  PubMed  Google Scholar 

  24. Smirk C, Morris H. The anatomy and reconstruction of the medial patellofemoral ligament. Knee. 2003;10(3):221–7.

    Article  PubMed  Google Scholar 

  25. Wijdicks CA, Griffith CJ, LaPrade RF, et al. Radiographic identification of the primary medial knee structures. J Bone Joint Surg Am. 2009;91(3):521–9.

    Article  PubMed  Google Scholar 

  26. Ishikawa M, Hoo C, Ishifuro M, et al. Application of a true lateral virtual radiograph from 3D-CT to identify the femoral reference point of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc. 2021;29(11):3809–17.

    Article  PubMed  Google Scholar 

  27. Malatray M, Magnussen R, Lustig S, et al. Lateral retinacular release is not recommended in association to MPFL reconstruction in recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc. 2019;27(8):2659–64.

    Article  PubMed  Google Scholar 

  28. Merican AM, Amis AA: Anatomy of the lateral retinaculum of the knee. https://www.ncbi.nlm.nih.gov/pubmed/18378934. J Bone Joint Surg Br. 2008;90(4):527–534.

  29. Migliorini F, Trivellas A, Colarossi G, et al. Single- versus double-bundle patellar graft insertion for isolated MPFL reconstruction in patients with patellofemoral instability: a systematic review of the literature. Arch Orthop Trauma Surg. 2020;140(6):769–76.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Migliorini F, Trivellas A, Driessen A, et al. Graft choice for isolated MPFL reconstruction: gracilis versus semitendinosus. Eur J Orthop Surg Traumatol. 2020;30(5):763–70.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Fathalla I, Holton J, Ashraf T. Examination under anesthesia in patients with recurrent patellar dislocation: prognostic study. J Knee Surg. 2019;32(4):361–5.

    Article  PubMed  Google Scholar 

  32. Shultz CL, Schrader SN, Packard BD, et al. Is diagnostic arthroscopy at the time of medial patellofemoral ligament reconstruction necessary?. Orthop J Sports Med. 2020;8(8):2325967120945654.

    Google Scholar 

  33. Pérez-Prieto D, Portillo ME, Torres-Claramunt R, et al. Contamination occurs during ACL graft harvesting and manipulation, but it can be easily eradicated. Knee Surg Sports Traumatol Arthrosc. 2018;26(2):558–62.

    Article  PubMed  Google Scholar 

  34. Gould HP, Delaney NR, Parks BG, et al. Interference screw versus suture anchors for femoral fixation in medial patellofemoral ligament reconstruction: a biomechanical study. Orthop J Sports Med. 2021. https://doi.org/10.1177/2325967121989282.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ackermann J, Mestriner AB, Merkeley G, et al. Femoral interference screw insertion significantly increases graft tension in medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2021;29(9):2851–6.

    Article  PubMed  Google Scholar 

  36. Mountney J, Senavongse W, Amis AA, et al. Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg Br. 2005;87(1):36–40.

    Article  CAS  PubMed  Google Scholar 

  37. Stephen JM, Kittl C, Williams A, et al. Effect of medial patellofemoral ligament reconstruction method on patellofemoral contact pressures and kinematics. Am J Sports Med. 2016;44(5):1186–94.

    Article  PubMed  Google Scholar 

  38. Stephen JM, Lumpaopong P, Deehan DJ, et al. The medial patellofemoral ligament: Location of femoral attachment and length change patterns resulting from anatomic and nonanatomic attachments. Am J Sports Med. 2012;40(8):1871–9.

    Article  PubMed  Google Scholar 

  39. Melegari TM, Parks BG, Matthews LS. Patellofemoral contact area and pressure after medial patellofemoral ligament reconstruction. Am J Sports Med. 2008;36(4):747–52.

    Article  PubMed  Google Scholar 

  40. Sanchis-Alfonso V, Ginovart G, Alastruey-Lopez D, et al. Evaluation of patellar contact pressure changes after static versus dynamic medial patellofemoral ligament reconstructions using a finite element model. J Clin Med. 2019. https://doi.org/10.3390/jcm8122093.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kim JM, Sim JA, Yang HY, et al. Clinical comparison of medial patellofemoral ligament reconstruction with or without tibial tuberosity transfer for recurrent patellar instability. Am J Sports Med. 2021;49(12):3335–43.

    Article  PubMed  Google Scholar 

  42. Sanchis-Alfonso V. How to deal with chronic patellar instability: What does the literature tell us? Sports Health: A Multidisciplinary Approach. 2016;8(1):86–90.

    Article  Google Scholar 

  43. Caplan N, Lees D, Newby M, et al. Is tibial tuberosity-trochlear groove distance an appropriate measure for the identification of knees with patellar instability? Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2377–81.

    Article  CAS  PubMed  Google Scholar 

  44. Matsushita T, Kuroda R, Oka S, et al. Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2438–44.

    Article  PubMed  Google Scholar 

  45. Hiemstra LA, Kerslake S, Lafave MR, et al. Patella alta is reduced following MPFL reconstruction but has no effect on quality-of-life outcomes in patients with patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 2021;29(2):546–52.

    Article  PubMed  Google Scholar 

  46. Bartsch A, Lubberts B, Mumme M, et al. Does patella alta lead to worse clinical outcome in patients who undergo isolated medial patellofemoral ligament reconstruction? A systematic review. Arch Orthop Trauma Surg. 2018;138(11):1563–73.

    Article  PubMed  Google Scholar 

  47. Fujii Y, Nakagawa S, Arai Y, et al. Clinical outcomes after medial patellofemoral ligament reconstruction: an analysis of changes in the patellofemoral joint alignment. Int Orthop. 2021;45(5):1215–22.

    Article  PubMed  Google Scholar 

  48. Menetrey J, Putman S, Gard S. Return to sport after patellar dislocation or following surgery for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2320–6.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Sappey-Marinier E, Sonnery-Cottet B, O´Loughlin P, et al. Clinical outcomes and predictive factors for failure with isolated MPFL reconstruction for recurrent patellar instability: a series of 211 reconstructions with a minimum follow-up of 3 years. Am J Sports Med. 2019;47(6):1323–30.

    Google Scholar 

  50. Schneider DK, Grawe B, Magnussen RA, et al. Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations: a systematic review and meta-analysis. Am J Sports Med. 2016;44(11):2993–3005.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Platt BN, Bowers LC, Magnuson JA, et al. Return to sport after medial patellofemoral ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2021. https://doi.org/10.1177/0363546521990004.

    Article  PubMed  Google Scholar 

  52. Hurley ET, Markus DH, Mannino BJ, et al. Patients unable to return to play following medial patellofemoral ligament reconstructions demonstrate poor psychological readiness. Knee Surg Sports Traumatol Arthrosc. 2021. https://doi.org/10.1007/s00167-021-06440-y.

    Article  PubMed  Google Scholar 

  53. Moreland CM, SZhaw KA, Burks R, et al. Primary medial patellofemoral ligament reconstruction in military service members: can we reliably restore preinjury function and stability?. Orthop J Sports Med. 2021. https://doi.org/10.1177/23259671211013334.

  54. Marot V, Sanchis-Alfonso V, Perelli S, et al. Isolated reconstruction of medial patellofemoral ligament with an elastic femoral fixation leads to excellent clinical results. Knee Surg Sports Traumatol Arthrosc. 2021;29(3):800–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Vicente Sanchis-Alfonso

  2. ICATME, Hospital Universitari Dexeus, UAB, Barcelona, Spain

    Maximiliano Ibañez

  3. Medical Imaging Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain

    Cristina Ramirez-Fuentes

  4. Hospital del Mar, Barcelona, Spain

    Joan Carles Monllau

  5. Catalan Institute of Traumatology and Sports Medicine (ICATME), Hospital Universitari Dexeus, Barcelona, Spain

    Joan Carles Monllau

  6. Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    Joan Carles Monllau

Authors
  1. Vicente Sanchis-Alfonso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maximiliano Ibañez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cristina Ramirez-Fuentes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joan Carles Monllau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vicente Sanchis-Alfonso .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Vicente Sanchis-Alfonso

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sanchis-Alfonso, V., Ibañez, M., Ramirez-Fuentes, C., Monllau, J.C. (2023). Medial Patellofemoral Ligament Reconstruction: Anatomical Versus Quasi-anatomical Femoral Fixation. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, Cham. https://doi.org/10.1007/978-3-031-09767-6_27

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-09767-6_27

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-09766-9

  • Online ISBN: 978-3-031-09767-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation