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The purpose of this study was to investigate the anatomical morphology and measurement of the medial patellofemoral ligament (MPFL), especially the femoral attachment. A total of 20 knee specimens were dissected and the total length, width, thickness, inclination, as well as the attachment points of the MPFL were measured. The MPFL was well-developed in seven knees, moderate in ten knees and wispy in three knees. Total length of the MPFL was 58.8 +/- 4.7 mm. The width and thickness was 12.0 +/- 3.1 mm and 0.44 +/- 0.19 mm at the middle point. The long axis of the MPFL inclined at 15.9 +/- 5.6 degrees proximally. The center of the patellar attachment was located at 27 +/- 10% from the upper end of the patella in the longitudinal patellar height. The femoral attachment was superoposterior to the medial femoral epicondyle and just distal to the adductor tubercle. The center of the anterior edge of the femoral attachment was 9.5 +/- 1.8 mm proximally and 5.0 +/- 1.7 mm posteriorly from the center of the medial femoral epicondyle. The femoral attachment was located at 61 +/- 4% of anteroposterior length of the medial femoral condyle from the anterior edge.

The remnants of the medial patello-femoral ligament (MPFL) of 67 knees, 18 with acute patellar dislocation and 49 with chronic patellar dislocation, were studied. The MPFL injuries of the acute cases were categorised into 2 groups: an avulsion tear type and a substantial tear type. The chronic cases were put into 3 groups: those with loose femoral attachment (9 knees), those with scar tissue formation or abnormal scar branch formation (29 knees), and those with no evidence or continuity of the ligament (absent type) (11 knees). It is concluded that incompetence of the medial patello-femoral ligament is a major factor in the occurrence of recurrent patellar dislocation and/or an unstable patella following an acute patellar dislocation.

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The association of definite knee osteoarthritis in medial patellofemoral ligament reconstruction with or without lateral release was small in the long-term follow-up. The conclusion is that medial patellofemoral ligament reconstruction not only prevents further patellar dislocation but also shows no or only slight progression of knee osteoarthritis.

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