Miho J Tanaka1, Jorge Chahla2, Jack Farr3, Robert F LaPrade4, Elizabeth A Arendt5, Vicente Sanchis-Alfonso6, William R Post7, John P Fulkerson8,9. 1. Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., Suite 5250, 21287, Baltimore, MD, USA. Mtanaka4@jhmi.edu. 2. Cedars-Sinai Kerlan Jobe Institute, Santa Monica, CA, USA. 3. OrthoIndy Knee Preservation and Cartilage Restoration Center, Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. 4. The Steadman Clinic, Vail, CO, USA. 5. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA. 6. Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain. 7. Mountaineer Orthopedic Specialists, LLC, Morgantown, WV, USA. 8. Orthopedic Associates of Hartford, Farmington, CT, USA. 9. Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, CT, USA.
Abstract
PURPOSE: The scientific literature concerning the anatomy of medial soft-tissue stabilizers of the patella is growing exponentially. Much of the surgical literature has focused on the role of the medial patellofemoral ligament (MPFL) and techniques to reconstruct it, yet our understanding of its anatomy has evolved during the past several years. Given this, we report on the current understanding of medial patellofemoral anatomy and implications for reconstruction. METHODS: Current and historical studies of medial patellar anatomy were reviewed, which include the MPFL and medial quadriceps tendon femoral ligament (MQTFL), as well as that of the distal medial patellar restraints, the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML). In addition to the reported findings, the authors' anatomic descriptions of each ligament during their dissections were identified and recorded. RESULTS: Despite the name of the MPFL, which implies that the ligament courses between the femur and patella, recent studies have highlighted the proximal MPFL fibers that attach to the quadriceps tendon, known as the MQTFL. The MPFL and MQTFL have also been referred to as the medial patellofemoral complex, reflecting the variability in anatomical attachment sites. The MPFL accounts for only half of the total restraint to lateral patellar displacement, and the remaining contributions to patellar stability are derived from the combination of the MPTL and MPML, which function primarily in greater degrees of knee flexion. CONCLUSION: The understanding of the complexity of the medial patellar stabilizers continues to evolve. Although MPFL reconstruction is gaining wide acceptance as a procedure to treat patellar instability, it is important to recognize the complex and changing understanding of the anatomy of the medial soft-tissue stabilizers and the implications for reconstruction. LEVEL OF EVIDENCE: V.
PURPOSE: The scientific literature concerning the anatomy of medial soft-tissue stabilizers of the patella is growing exponentially. Much of the surgical literature has focused on the role of the medial patellofemoral ligament (MPFL) and techniques to reconstruct it, yet our understanding of its anatomy has evolved during the past several years. Given this, we report on the current understanding of medial patellofemoral anatomy and implications for reconstruction. METHODS: Current and historical studies of medial patellar anatomy were reviewed, which include the MPFL and medial quadriceps tendon femoral ligament (MQTFL), as well as that of the distal medial patellar restraints, the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML). In addition to the reported findings, the authors' anatomic descriptions of each ligament during their dissections were identified and recorded. RESULTS: Despite the name of the MPFL, which implies that the ligament courses between the femur and patella, recent studies have highlighted the proximal MPFL fibers that attach to the quadriceps tendon, known as the MQTFL. The MPFL and MQTFL have also been referred to as the medial patellofemoral complex, reflecting the variability in anatomical attachment sites. The MPFL accounts for only half of the total restraint to lateral patellar displacement, and the remaining contributions to patellar stability are derived from the combination of the MPTL and MPML, which function primarily in greater degrees of knee flexion. CONCLUSION: The understanding of the complexity of the medial patellar stabilizers continues to evolve. Although MPFL reconstruction is gaining wide acceptance as a procedure to treat patellar instability, it is important to recognize the complex and changing understanding of the anatomy of the medial soft-tissue stabilizers and the implications for reconstruction. LEVEL OF EVIDENCE: V.
Authors: Robert F LaPrade; Anders Hauge Engebretsen; Thuan V Ly; Steinar Johansen; Fred A Wentorf; Lars Engebretsen Journal: J Bone Joint Surg Am Date: 2007-09 Impact factor: 5.284
Authors: José Aderval Aragão; Francisco Prado Reis; Diego Protásio de Vasconcelos; Vera Lúcia Corrêa Feitosa; Marco Antonio Prado Nunes Journal: Clinics (Sao Paulo) Date: 2008-08 Impact factor: 2.365
Authors: Vicente Sanchis-Alfonso; Gerard Ginovart; Diego Alastruey-López; Erik Montesinos-Berry; Joan Carles Monllau; Angel Alberich-Bayarri; María Angeles Pérez Journal: J Clin Med Date: 2019-12-01 Impact factor: 4.241
Authors: Kelly H McFarlane; Ryan P Coene; Lanna Feldman; Patricia E Miller; Benton E Heyworth; Dennis E Kramer; Mininder S Kocher; Yi-Meng Yen; Matthew D Milewski Journal: J Child Orthop Date: 2021-04-19 Impact factor: 1.548