Morphology of insertion sites on patellar side of medial patellofemoral ligament

Kikuchi, Shuhei; Tajima, Goro; Jing, Yan; Kamei, Youichi; Maruyama, Moritaka; Sugawara, Atsushi; Fujino, Kotaro; Takeda, Sanjuro; Doita, Minoru

doi:10.1007/s00167-015-3973-1

Cited by 11 publications

(9 citation statements)

References 29 publications

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“…Relative to the MPFL patellar insertion site, Kikuchi et al[ 13 ] have recently shown that it is largely consistent. Most of its fibers insert more into the vastus medialis obliquus (VMO) and vastus intermedius than into the patella.…”

Section: Mpfl Reconstruction Failure Due To a Technical Errormentioning

confidence: 99%

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Sanchis-Alfonso

Montesinos-Berry

Ramírez-Fuentes

et al. 2017

WJO

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Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.

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Section: Mpfl Reconstruction Failure Due To a Technical Errormentioning

confidence: 99%

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Sanchis-Alfonso

Montesinos-Berry

Ramírez-Fuentes

et al. 2017

WJO

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“…All the in vivo studies 17,34,57 measured anatomic parameters of the ligament in healthy participants using MRI. While most in vitro studies § dissected cadaveric knee specimens and measured the MPFL manually using simple tools such as calipers or rulers, 1 in vitro study 42 measured the MPFL length and attachment sites using CT. An additional 5 in vitro studies 33,60,66,89,99 did not clearly mention the measurement technique for assessing the anatomy.…”

Section: Anatomy Of the Mpflmentioning

confidence: 99%

Properties and Function of the Medial Patellofemoral Ligament: A Systematic Review

et al. 2019

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Background: As the main passive structure preventing patellar lateral subluxation, accurate knowledge of the anatomy, material properties, and functional behavior of the medial patellofemoral ligament (MPFL) is critical for improving its reconstruction. Purpose: To provide a state-of-the-art understanding of the properties and function of the MPFL by undertaking a systematic review and statistical analysis of the literature. Study Design: Systematic review. Methods: On June 26, 2018, data for this systematic review were obtained by searching PubMed and Scopus. Articles containing numerical information regarding the anatomy, mechanical properties, and/or functional behavior of the MPFL that met the inclusion criteria were reviewed, recorded, and statistically evaluated. Results: A total of 55 articles met the inclusion criteria for this review. The MPFL presented as a fanlike structure spanning from the medial femoral epicondyle to the medial border of the patella. The reported data indicated ultimate failure loads from 72 N to 208 N, ultimate failure elongation from 8.4 mm to 26 mm, and stiffness values from 8.0 N/mm to 42.5 N/mm. In both cadaveric and in vivo studies, the average elongation pattern demonstrated close to isometric behavior of the ligament in the first 50° to 60° of knee flexion, followed by progressive shortening into deep flexion. Kinematic data suggested clear lateralization of the patella in the MPFL-deficient knee during early knee flexion under simulated muscle forces. Conclusion: A lack of knowledge regarding the morphology and attachment sites of the MPFL remains. The reported mechanical properties also lack consistency, thus requiring further investigations. However, the results regarding patellar tracking confirm that the lack of an MPFL leads to lateralization of the patella, followed by delayed engagement of the trochlear groove, plausibly leading to an increased risk of patellar dislocations. The observed isometric behavior up to 60° of knee flexion plausibly suggests that reconstruction of the ligament can occur at flexion angles below 60°, including the 30° and 60° range as recommended in previous studies.

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“…52 Most of the studies in the last 2 years are in agreement that the MPFC attaches more proximally than we thought, having a connection to the medial border of the vastus intermedius tendon (Table 1). 40,41,[43][44][45]47,49,50 My colleagues and I performed a cadaveric dissection and found similar findings; that MPFC originates from a midpoint between the femoral epicondyle and adductor tubercle. It fans out into 2 bands: a main thick band to the upper half of the patella and a thin upper layer running anteriorly, upward, then under the vastus medialis obliquus.…”

mentioning

confidence: 63%

Editorial Commentary: Medial Patellofemoral Complex: Driving a Better Understanding of Medial Knee Anatomy

Sobhy¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Morphology of insertion sites on patellar side of medial patellofemoral ligament

Cited by 11 publications

References 29 publications

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

Properties and Function of the Medial Patellofemoral Ligament: A Systematic Review

Editorial Commentary: Medial Patellofemoral Complex: Driving a Better Understanding of Medial Knee Anatomy

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