Morphology of the femoral insertion site of the medial patellofemoral ligament

Abstract

The adductor tubercle was clearly identified as an osseous landmark. The femoral insertion of the MPFL was approximately 10 mm distal to the adductor tubercle. These findings may improve understanding of the anatomy of the femoral insertion of the MPFL and may assist surgeons in performing anatomical reconstruction.

Radiographic Reference Points Are Inaccurate With and Without a True Lateral Radiograph

“…LaPrade et al 19 reported the MPFL center to be located 1.9 mm anterior and 3.8 mm distal to the ATT and 10.6 mm proximal and 8.8 mm posterior to the ME. Like Fujino et al, 16 we found the ATT to be the most easily discernable prominence in the vicinity of the MPFL attachment. The apex of the ATT was easier to identify than the ME, which was a broad, flat elevation on the medial femoral condyle.…”

“…Although variability in the ATT position was also observed in this study, its distance relative to the MPFL attachment was fairly consistent, averaging 7.9 6 1.2 mm. Fujino et al 16 reported this distance to be 10.6 6 2.5 mm. The current study marked anatomic structures with steel spheres and measured distances on radiographs, while Fujino et al 16 made measurements on CT scans.…”

“…Fujino et al 16 reported this distance to be 10.6 6 2.5 mm. The current study marked anatomic structures with steel spheres and measured distances on radiographs, while Fujino et al 16 made measurements on CT scans. The methods in which measurements were made may reflect the slight difference noted; however, both reports agree on the utility of the ATT as a landmark.…”

“…Within this sulcus, it should be noted that the MPFL has a broad femoral attachment similarly reported in other studies. 4,16,49 Knees with anatomic anomalies such as patella alta, trochlear dysplasia, quadriceps dysplasia, patellar tilt, and anterior tibial tubercle lateralization have a reported high association with symptomatic patellar instability when compared with control knees 11 and may also have altered ME and ATT anatomy as suggested by Servien et al 34 Recent studies 16,31 reported great anatomic variability of the ATT position assessed with computed tomography (CT) scans. Likewise, Sanchis-Alfonso et al 31 argued against the use of radiographic methods, as they do not account for anatomic variations in medial knee anatomy, particularly the ATT, thereby reflecting an added risk for malposition.…”

Patellofemoral Joint Instability: A Review of Current Concepts

“…Hence, it could be called the confluence point [19,23]. This point is posterior to the line extending from the posterior cortex of the femur (Figure 2)-more than 5 mm distal and posterior to Schöttle's point [23,24,25,26,27,28] (Figure 4). Interestingly, this point corresponds to the instant center of knee rotation.…”