Betina Bremer Hinckel1, Riccardo Gomes Gobbi2, Camila Cohen Kaleka3, Gilberto Luis Camanho2, Elizabeth A Arendt4. 1. Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Ave, Columbia, MO, 65212, USA. 2. Orthopedics and Traumatology Institute, University of Sao Paulo, Ovidio Pires de Campos St, 333, Sao Paulo, SP, 5403-010, Brazil. 3. Albert Einstein Israelite Hospital, Av Albert Einstein, 627, Building A1, unit 306, Sao Paulo, SP, 05652-900, Brazil. 4. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA. arend001@umn.edu.
Abstract
PURPOSE: The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML. METHODS: A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML. RESULTS: The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML. The MPFL is considered the primary restraint to lateral patellar translation, while the latter two are considered secondary restraints. There is robust literature on the anatomical, imaging, and biomechanical characteristics of the MPFL, and also the clinical outcome of its injury and surgical reconstruction; much less is known about the MPTL and MPML. Isolated MPFL reconstruction has good clinical and functional outcomes, with a low failure rate when defined as frank re-dislocation. Complications, including continued episodes of patellar apprehension and subluxation, remain present in most series. In addition, the current literature primarily includes a homogeneous population with few excessive anatomic dysplastic factors. There is lack of knowledge on the role of MPTL and MPML in (potentially) aiding patella stabilization and improving clinical outcomes. Understanding the role of the medial-sided patellar ligaments, in particular the role of the secondary stabilizers, in PF function and injury will aid in this goal. CONCLUSION: MPTL and MPML have consistent basic science literature, as well as favorable clinical outcomes of surgical patellar stabilization with reconstruction of the MPTL. However, there is much heterogeneity among clinical case series and lack of comparative studies to allow clear indication for the role of isolated or combined surgical reconstruction in patellar stabilization. Therefore, this comprehensive review helps understand the current knowledge and the possible applications in the orthopedic clinical practice. LEVEL OF EVIDENCE: V.
PURPOSE: The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML. METHODS: A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML. RESULTS: The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML. The MPFL is considered the primary restraint to lateral patellar translation, while the latter two are considered secondary restraints. There is robust literature on the anatomical, imaging, and biomechanical characteristics of the MPFL, and also the clinical outcome of its injury and surgical reconstruction; much less is known about the MPTL and MPML. Isolated MPFL reconstruction has good clinical and functional outcomes, with a low failure rate when defined as frank re-dislocation. Complications, including continued episodes of patellar apprehension and subluxation, remain present in most series. In addition, the current literature primarily includes a homogeneous population with few excessive anatomic dysplastic factors. There is lack of knowledge on the role of MPTL and MPML in (potentially) aiding patella stabilization and improving clinical outcomes. Understanding the role of the medial-sided patellar ligaments, in particular the role of the secondary stabilizers, in PF function and injury will aid in this goal. CONCLUSION: MPTL and MPML have consistent basic science literature, as well as favorable clinical outcomes of surgical patellar stabilization with reconstruction of the MPTL. However, there is much heterogeneity among clinical case series and lack of comparative studies to allow clear indication for the role of isolated or combined surgical reconstruction in patellar stabilization. Therefore, this comprehensive review helps understand the current knowledge and the possible applications in the orthopedic clinical practice. LEVEL OF EVIDENCE: V.
Authors: Camila Cohen Kaleka; Leandro Jun Aihara; Anderson Rodrigues; Sebastião Ferreira de Medeiros; Victor Marques de Oliveira; Ricardo de Paula Leite Cury Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-10-08 Impact factor: 4.342
Authors: Christopher L Camp; Aaron J Krych; Diane L Dahm; Bruce A Levy; Michael J Stuart Journal: Am J Sports Med Date: 2010-08-17 Impact factor: 6.202
Authors: Charles A Baumann; Eli L Pratte; Seth L Sherman; Elizabeth A Arendt; Betina B Hinckel Journal: Knee Surg Sports Traumatol Arthrosc Date: 2018-01-17 Impact factor: 4.342
Authors: Miho J Tanaka; Jorge Chahla; Jack Farr; Robert F LaPrade; Elizabeth A Arendt; Vicente Sanchis-Alfonso; William R Post; John P Fulkerson Journal: Knee Surg Sports Traumatol Arthrosc Date: 2018-10-28 Impact factor: 4.342
Authors: Reed G Coda; Sana G Cheema; Christina Hermanns; Meghan Kramer; Armin Tarakemeh; John P Schroeppel; Scott Mullen; Bryan G Vopat; Mary K Mulcahey Journal: Arthrosc Sports Med Rehabil Date: 2021-01-30
Authors: Ferdinand Wagner; Günther Maderbacher; Jan Matussek; Boris M Holzapfel; Birgit Kammer; Jochen Hubertus; Sven Anders; Sebastian Winkler; Joachim Grifka; Armin Keshmiri Journal: Adv Orthop Date: 2019-09-15
Authors: Paolo Ferrua; Bradley M Kruckeberg; Stefano Pasqualotto; Massimo Berruto; Pietro Randelli; Elizabeth A Arendt Journal: J Orthop Traumatol Date: 2019-03-26