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

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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Laboratoire de Physiologie de l’Exercice, EA 4338, Saint Etienne, France

    R. Philippot & F. Farizon

  2. Service de chirurgie orthopédique, Centre Hospitalier et universitaire de Saint Etienne, 42055, Saint Etienne, Cedex 2, France

    R. Philippot, B. Boyer & F. Farizon

  3. Laboratoire de Biomécanique et Mécanique des Chocs, UMR-T 9406, 69675, Bron, France

    R. Testa & B. Moyen

  4. Service de chirurgie orthopédique, Centre hospitalier Lyon Sud chemin Grand Revoyet, 69310, Pierre Bénite, France

    R. Testa & B. Moyen

  5. Orthopaedic surgery department, North Hospital, 42055, Saint Etienne, Cedex 2, France

    R. Philippot

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  1. R. Philippot
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  2. B. Boyer
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  3. R. Testa
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  4. F. Farizon
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  5. B. Moyen
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Correspondence to R. Philippot.

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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). https://doi.org/10.1007/s00167-011-1598-6

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  • DOI: https://doi.org/10.1007/s00167-011-1598-6

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