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Medial patellofemoral ligament anatomy: is it a predisposing factor for lateral patellar dislocation?

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Abstract

Purpose

Because the medial patellofemoral ligament (MPFL) is the primary restraint to lateral dislocation of the patella, we aimed, in this controlled study, to verify whether the MPFL with different measurements could be considered another predisposing factor for patellar dislocation.

Methods

A group of 100 consecutive individuals without the criteria for patellar dislocation (trochlear dysplasia, patella alta and lateral patellar tilt) was recruited as a control group and underwent magnetic resonance imaging (MRI) study and another group of 50 patients with patellar instability. Femoral condyles, interepicondylar distance, length and thickness of the MPFL were measured.

Results

In the control group, the MPFL was 38–60 mm long. Individuals with patellar instability who had no episode of patellar dislocation had a 4.11-mm longer ligament than controls (p = 0.032), while patients with instability with a previous history of dislocation had a 13.54-mm longer MPFL than controls (p < 0.001). Thickness of the MPFL at the patellar insertion was lower in individuals with patellar instability with a history of dislocation (p < 0.001). An instability coefficient (IC) less than 1.3 indicates that the MPFL is insufficient.

Conclusions

Individuals with patellar instability and previous patellar dislocation present with longer MPFL when compared to controls, and an associated IC less than 1.3 can be considered a predisposing factor for patellar dislocation. Treatment of patellar instability is a challenge, and it is difficult to identify what is the predisposing factor. This study has verified the measurements of the MPFL for the first time and presents values of thickness and length that can be considered as indications for surgical reconstruction.

Level of evidence: III.

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References

  1. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26

    Article  CAS  PubMed  Google Scholar 

  2. Bollier M, Fulkerson JP (2011) The role of trochlear dysplasia in patellofemoral instability. J Am Acad Orthop Surg 19(1):8–16

    PubMed  Google Scholar 

  3. Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30(4):961–981

    Article  PubMed  Google Scholar 

  4. Lewallen LW, McIntosh AL, Dahm DL (2013) Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med 41(3):575–580

    Article  PubMed  Google Scholar 

  5. Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R (2013) Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 41(2):374–384

    Article  PubMed  Google Scholar 

  6. Arendt EA (2005) Anatomy and malalignment of the patellofemoral joint: its relation to patellofemoral arthrosis. Clin Orthop Relat Res 436:71–75

    Article  PubMed  Google Scholar 

  7. Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23(5):542–553

    Article  PubMed  Google Scholar 

  8. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220

    Article  CAS  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Aragão 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 63(4):541–544

    Article  PubMed Central  PubMed  Google Scholar 

  12. LeGrand AB, Greis PE, Dobbs RE, Burks RT (2007) MPFL reconstruction. Sports Med Arthrosc 15(2):72–77

    Article  PubMed  Google Scholar 

  13. Guerrero P, Li X, Patel K, Brown M, Busconi B (2009) Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study. Sports Med Arthrosc Rehabil Ther Technol 1(1):17

    Article  PubMed Central  PubMed  Google Scholar 

  14. Reider B, Marshall JL, Koslin B, Ring B, Girgis FG (1981) The anterior aspect of the knee joint. J Bone Joint Surg Am 63(3):351–356

    CAS  PubMed  Google Scholar 

  15. Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75(5):682–693

    CAS  PubMed  Google Scholar 

  16. Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia: MR findings. Radiology 216(3):858–864

    Article  CAS  PubMed  Google Scholar 

  17. 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 Am J Roentgenol 191(2):490–498

    Article  PubMed  Google Scholar 

  18. Starok M, Lenchik L, Trudell D, Resnick D (1997) Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation. AJR Am J Roentgenol 168(6):1493–1499

    Article  CAS  PubMed  Google Scholar 

  19. Balcarek P, Ammon J, Frosch S, Walde TA, Schüttrumpf JP, Ferlemann KG et al (2010) Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy 26(7):926–935

    Article  PubMed  Google Scholar 

  20. Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW (2011) Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 39(7):1444–1449

    Article  PubMed  Google Scholar 

  21. Weber-Spickschen TS, Spang J, Kohn L, Imhoff AB, Schottle PB (2011) The relationship between trochlear dysplasia and medial patellofemoral ligament rupture location after patellar dislocation: an MRI evaluation. Knee 18(3):185–188

    Article  CAS  PubMed  Google Scholar 

  22. Higuchi T, Arai Y, Takamiya H, Miyamoto T, Tokunaga D, Kubo T (2010) An analysis of the medial patellofemoral ligament length change pattern using open-MRI. Knee Surg Sports Traumatol Arthrosc 18(11):1470–1475

    Article  PubMed  Google Scholar 

  23. Santos Neto A, Brito MBS, Severino FR, Campos LRA, Nico MAC, Oliveira VM et al (2012) Estudo da articulação patelofemoral por ressonância magnética: a variação da morfologia do ligamento patelofemoral medial [Study on the patellofemoral joint using magnetic resonance imaging: morphological variation of the medial patellofemoral ligament]. Rev Bras Ortop 47(2):204–209

    Article  Google Scholar 

  24. Wiberg G (1941) Roentgenographic and anatomic studies on the femoropatellar joint: with special reference to chondromalacia patellae. Acta Orthop 12(1–4):319–410, Available via: http://www.deepdyve.com/lp/informa-healthcare/roentgenographs-and-anatomic-studies-on-the-femoropatellar-joint-with-n8Np7ClseO. Accessed 26 June 2013

    Google Scholar 

  25. Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 61(1):56–62

    CAS  PubMed  Google Scholar 

  26. Gomes JLE, Marczyk LRS, César PC, Jungblut CF (2003) Reconstrução do ligamento patelofemoral medial: sua indicação na luxação da patela [Medial patellofemoral ligament reconstruction: indications in chronic patellar instability]. Rev Bras Ortop 38(1/2):56–66

    Google Scholar 

  27. Ellera Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8(3):335–340

    Article  CAS  PubMed  Google Scholar 

  28. Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24(1):52–60

    Article  CAS  PubMed  Google Scholar 

  29. Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23(5):260–263

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Camanho GL, Viegas AC (2003) Estudo anatômico e artroscópico do ligamento femoropatelar medial [Anatomic and arthroscopic study of the medial femoropatellar ligament]. Acta Orthop Bras 11(3):145–149

    Google Scholar 

  31. Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225(3):736–743

    Article  PubMed  Google Scholar 

  32. Sillanpää PJ, Peltola E, Mattila VM, Kiuru M, Visuri T, Pihlajamäki H (2009) Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: a mean 7-year nonoperative follow-up study. Am J Sports Med 37(8):1513–1521

    Article  PubMed  Google Scholar 

  33. Arendt EA, Dejour D (2013) Patella instability: building bridges across the ocean, a historic review. Knee Surg Sports Traumatol Arthrosc 21:279–293

    Article  PubMed  Google Scholar 

  34. Matthews JJ, Schranz P (2010) Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique. Int Orthop 34:1321–1325

    Article  PubMed Central  PubMed  Google Scholar 

  35. Wang C, Ma L, Zhou J, Ji G, Wang H, Wang F, Wang J (2013) Double-bundle anatomical versus single-bundle isometric medial patellofemoral ligament reconstruction for patellar dislocation. Int Orthop 37:617–624

    Article  PubMed Central  PubMed  Google Scholar 

  36. Ntagiopoulos PG, Sharma B, Bignozzi S, Lopomo N, Colle F, Zaffagnini S, Dejour D (2013) Are the tubular grafts in the femoral tunnel in an anatomical or isometric position in the reconstruction of medial patellofemoral ligament? Int Orthop 37:1933–1941

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic and Traumatology, Santa Casa Medical School and Hospitals, São Paulo, Brazil

    Victor de Oliveira, Ricardo Cury, Osmar Pedro Camargo, Osmar Avanzi, Nilson Severino & Patricia Fucs

  2. Radiology Department, Santa Casa Medical School and Hospitals, São Paulo, Brazil

    Vanessa de Souza

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  1. Victor de Oliveira
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  2. Vanessa de Souza
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  3. Ricardo Cury
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  4. Osmar Pedro Camargo
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  5. Osmar Avanzi
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  6. Nilson Severino
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  7. Patricia Fucs
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Correspondence to Patricia Fucs.

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de Oliveira, V., de Souza, V., Cury, R. et al. Medial patellofemoral ligament anatomy: is it a predisposing factor for lateral patellar dislocation?. International Orthopaedics (SICOT) 38, 1633–1639 (2014). https://doi.org/10.1007/s00264-014-2357-3

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  • DOI: https://doi.org/10.1007/s00264-014-2357-3

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