Anatomical study of the medial patello-femoral ligament: landmarks for its surgical reconstruction

Viste, Anthony; Chatelet, Florian; Desmarchelier, Romain; Fessy, Michel‐Henri

doi:10.1007/s00276-014-1270-1

Cited by 32 publications

(33 citation statements)

References 28 publications

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“…In all three studies, differentiation between ALL fibers and the lateral meniscus body was difficult to characterize, but none of those studies was specifically focused on the analysis of this insertion. Our study showed spreading of the fibers immediately before their insertion on the lateral meniscus, similar to what happens with the medial femoropatellar ligament upon its insertion in the patella [2,29]. With the growing search for improvements in reconstruction techniques for the ACL and the increased popularity of extra-articular reconstruction techniques associated with intra-articular reconstructions, it is possible that literature for ALL reconstruction will appear soon [14,26,27].…”

Section: Discussionsupporting

confidence: 61%

The meniscal insertion of the knee anterolateral ligament

et al. 2015

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Section: Discussionsupporting

confidence: 61%

The meniscal insertion of the knee anterolateral ligament

et al. 2015

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“…It has been observed that the distance between the adductor tubercle and the femoral insertion of the MPFL has lower variations than that between the medial femoral epicondyle and the femoral insertion of the MPFL. 17 That is the reason why some authors advocate the use of the adductor tubercle as a landmark for MPFL reconstruction instead of the medial femoral epicondyle. 17 Moreover, the adductor tubercle is a well-defined anatomic landmark and therefore easier to identify than the medial femoral epicondyle.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have shown that the femoral insertion of the MPFL is located distal to the adductor tubercle at the midpoint between the medial femoral epicondyle and the adductor tubercle. 5 , 7 , 15 – 18 According to Fujino et al, 4 the femoral attachment of the MPFL is distal to the apex of the adductor tubercle and parallel to the long axis of the femur; the mean linear distance between the 2 points was 10.6 mm, and the position of the insertion site was consistent in all knees. The great variability in the location of the adductor tubercle explains the variability in the location of the femoral insertion of the MPFL.…”

Section: Methodsmentioning

confidence: 98%

“…One of the tunnels was created using the adductor tubercle as a landmark because it is a well-defined anatomic point of reference and because the relationship between the adductor tubercle and the femoral insertion of the MPFL is constant (∼1 cm). 4 , 15 , 17 , 18 This was considered as the anatomic tunnel ( Figure 1A ). The other was created according the radiological method described by Schöttle et al 12 ( Figure 1B ).…”

Section: Methodsmentioning

confidence: 99%

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Radiographic Location Does Not Ensure a Precise Anatomic Location of the Femoral Fixation Site in Medial Patellofemoral Ligament Reconstruction

Sanchis-Alfonso

Ramírez-Fuentes

Montesinos-Berry

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:A frequently used method to determine the anatomic femoral fixation point in the operating room during medial patellofemoral ligament (MPFL) reconstruction is the radiographic method. However, the ability of this radiological method to establish an anatomic femoral attachment point might not be as accurate as expected.Purpose:(1) To evaluate the accuracy of the radiological method to locate the anatomic femoral fixation point in MPFL reconstruction surgery and (2) to determine the factors influencing the predictability of this method to obtain this objective.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A total of 100 consecutive 3-dimensional computed tomography (3D CT) knee examinations were performed at 0° of extension in 87 patients treated for chronic lateral patellar instability. For each knee, 2 virtual 7 mm–diameter femoral tunnels were created: 1 using the adductor tubercle as a landmark (anatomic tunnel) and the other according to the radiological method described by Schöttle et al (radiographic tunnel). We measured the percentage of overlap between both tunnels. Moreover, of the 100 included knees, 10 were randomly selected for a variability study.Results:Considering an overlap area greater than 50% as reasonable, the radiographic method achieved this in only 38 of the 100 knees. Intrarater and interrater reliability were excellent. There was a trend for female patients with severe trochlear dysplasia to have less overlap. This model accounted for 64.2% of the initial variability in the data.Conclusion:An exact anatomic femoral tunnel placement could not be achieved with the radiographic method. Radiography provided only an approximation and should not be the sole basis for the femoral attachment location. Moreover, in female patients with severe trochlear dysplasia, the radiographic method was less accurate in determining the anatomic femoral fixation point, although differences were not statistically significant.

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“…It is crucial to find intraoperatively the optimal femoral footprint in order to obtain the most consistent isometric graft length throughout the entire range of motion [22]. Several studies have accurately described the anatomy of the MPFL and its femoral insertion area [23][24][25][26][27][28]. These anatomical studies specify in detail the topographical relationship of the MPFL footprint with prominent osseous landmarks.…”

Section: Introductionmentioning

confidence: 99%