Anatomy and biomechanics of the medial patellofemoral ligament

Amis, Andrew A.; Firer, P; Mountney, J.; Senavongse, Wongwit; Thomas, NP

doi:10.1016/s0968-0160(03)00006-1

Cited by 638 publications

(677 citation statements)

References 14 publications

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“…The MPLF could be identified in 66.7% (12 of 18) of our limbs.Various reports, as reviewed by Amis et al [2], give differing frequencies of its presence for reasons that are not clear. When it is present, it exhibits considerable strength and contributes approximately 55% of the passive soft tissue resistance to lateral patellar subluxation [1].…”

Section: Discussionmentioning

confidence: 99%

“…Parameters such as the physiologic crosssectional area, a proxy measure for potential muscle force, and the angles formed by the fibers of the VMO and VLO and the longitudinal axis had significant variation among individuals in a cadaver study [12]. In addition, the quality of the static structures of the knee such as the medial and lateral retinacula and the closely associated patellofemoral ligaments appear to have a significant role in joint stability [2,13]. If this is true with the large variations studied so far, it is reasonable to hypothesize that smaller variations would have similar, if more subtle, effects.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee

Waligora

Johanson

Hirsch

2009

Clin Orthop Relat Res

121

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Most descriptions of the extensor mechanism of the knee do not take into account its complexity and variability. The quadriceps femoris insertion into the patella is said to be through a common tendon with a threelayered arrangement: rectus femoris (RF) most superficially, vastus medialis (VM) and lateralis (VL) in the intermediate layer, and vastus intermedius (VI) most deeply. We dissected 20 limbs from 17 cadavers to provide a more detailed description of the anterior components of the knee: the tendon, the patellar retinacula, and the patellofemoral ligaments. Only three of the 20 specimens exhibited the typically described quadriceps pattern. The remainder had bilaminar and even more complex trilaminar and tetralaminar fiber arrangements. We found an oblique head of the vastus lateralis (VLO), separated from the longitudinal head by a layer of fat or fascia, in 60% of the specimens. However, we found no distinct oblique head of the vastus medialis (VMO) in any specimen. The medial patellofemoral ligament (MPFL) was more common than the lateral (LPFL), supporting its suggested role as the principal passive medial stabilizer of the patella. Because the quadriceps muscle group plays a direct role in patellofemoral joint function, investigation into the clinical applications of its highly variable anatomy may be worthwhile with respect to joint dysfunction and failures of TKAs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee

Waligora

Johanson

Hirsch

2009

Clin Orthop Relat Res

121

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“…The nonoperative approach was widely accepted and commonly applied in acute patellar dislocation treatment until the end of the twentieth century. However, a high incidence of residual patellar instability, anterior knee pain, and redislocation of up to 44% in the representative studies [5][6][7], combined with advances in and a proper understanding of functional anatomy and biomechanics of the medial patellar stabilisers [8,9], led to expansion of primary surgical treatment for acute patellar dislocation [10]. Surgery is mainly based on immediate medial repair and proximal realignment procedures.…”

Section: Introductionmentioning

confidence: 99%

Acute patellar dislocation in adolescents: operative versus nonoperative treatment

Apostolović

Vukomanović

Slavković

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this prospective non-randomised study was to compare the efficacy of two opposed methods, operative and conservative. Our hypothesis was that if the method was selected correctly, on an individual basis, the results should be approximately equal. Methods The study included 37 adolescents aged between 12 and 16 years, with a mean follow up of 6.1 years. The presence of a significant loose body, confirmed by precise imaging, was the key for selecting operative or arthroscopic treatment. In both groups of patients, we evaluated functional knee scores and the incidence of residual patellofemoral disorders.Results We confirmed our hypothesis using the t-test to compare functional results and a test for comparison of proportions for incidence of residual disorders. There was no statistically significant difference (p=0.091) between operatively and conservatively treated groups with regard to functional results. The same statistical outcome emerged when comparing incidences of re-dislocation (p=0.854), or other major patellar instabilities (p=0.856), between the groups. Conclusions The results obtained should not promote a non-operative method on the basis of lower risk, but do support an individual approach based on precise diagnosis and defined criteria.

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“…MPFL is primary passive soft tissue restraint to lateral dislocation of patella and contributes 60% of the total restraining force against lateral patellar displacement. In most cases, MPFL rupture is an essential event in the first lateral patellar dislocation and it alters the patellofemoral joint instability for the worse [8,29,30]. On the other hand, it has reported that the length of MPFL in patients with patellar instability was longer than that in healthy controls, even knee with no episode of patellar dislocation [31].…”

Section: Discussionmentioning

confidence: 99%