The Anatomy of the Medial Patellofemoral Ligament

Trinh, Thai Q.; Ferrel, Jason R.; Bentley, Jared C.; Steensen, Robert N.

doi:10.3928/01477447-20170223-03

Cited by 11 publications

(10 citation statements)

References 42 publications

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“…The saddle sulcus has been anatomically 3 , 58 , 60 and radiographically 11 identified as an osseous depression or region where the MPFL is consistently attached. Considering previous descriptions of the MPFL femoral footprint, 1 , 21 , 24 , 48 , 52 we thus determined the saddle sulcus on the reconstructed femur as (1) being located within the boundaries of the AT, ME, and MGT; (2) lying posterior to the border connecting the apexes of the AT and ME; and (3) a broad, oblong, and oblique saddle-like sulcus. The 3D-reconstructed model was rotated to ultimately determine the presence of the saddle sulcus.…”

Section: Methodsmentioning

confidence: 99%

Computed Tomography Imaging Analysis of the MPFL Femoral Footprint Morphology and the Saddle Sulcus: Evaluation of 1094 Knees

Chen

Xiong

Han

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The medial patellofemoral ligament (MPFL) has been reported to be anatomically attached from an osseous saddle region (saddle sulcus) between neighboring landmarks on the femur, including the adductor tubercle (AT), medial epicondyle (ME), and medial gastrocnemius tubercle (MGT). However, the position and prevalence of the saddle sulcus remain unknown. Purpose: To study the femoral footprint of MPFL and the prevalence of the saddle sulcus with computed tomography (CT) imaging; quantify the position of the saddle sulcus; and determine the relevant factors of the identified position and measuring distances. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1094 knees in 753 patients were studied. Knees were organized into an anterior cruciate ligament reconstruction (ACLR) group (controls) and a recurrent patellar dislocation (RPD) group. Using 3-dimensionally reconstructed CT images, the authors determined the prevalence of the saddle sulcus and its position relative to the AT, the ME, the Schöttle point (1.3 mm anterior to the distal posterior cortex and 2.5 mm distal to the posterior origin of the medial femoral condyle), and the Fujino point (approximately 10 mm distal to the AT). Analysis of covariance was used to adjust for age, sex, side, and body mass index on the measurements. Results: There were 555 knees in the control group and 539 knees in the RPD group. The MPFL femoral footprint presented as an oblique, oblong, osseous region (saddle sulcus) in 75.7% of knees (75.0%, ACLR group vs 76.4%, RPD group; P < .001). The saddle sulcus was located a mean of 12.2 mm (95% CI, 12.0-12.4 mm) from a line connecting the apex of the AT to the ME (AT-ME) and a mean of 7.6 mm (95% CI, 7.5-7.8 mm) posteriorly perpendicular to that line. The location as a proportion of the AT-ME distance was 63.1% (95% CI, 62.6%-63.7%) in the X direction and 39.8% (95% CI, 39.1%-40.5%) in the Y direction. The Schöttle and Fujino points lay anterior and proximal to the saddle sulcus more than 5 mm away from the center of the saddle sulcus. Women had a higher prevalence of saddle sulcus (odds ratio [OR], 1.33 [95% CI, 1.00-1.75]; P = .046) compared with men. Conclusion: The saddle sulcus was identified in 75.7% of knees from the medial femoral aspect, with its center located consistently between the AT and ME.

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Section: Methodsmentioning

confidence: 99%

Computed Tomography Imaging Analysis of the MPFL Femoral Footprint Morphology and the Saddle Sulcus: Evaluation of 1094 Knees

Chen

Xiong

Han

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…This distance has been shown to be equivalent to the length of the intact native MPFL. 1 , 2 , 37 The tensile force applied to the graft was in the line of pull parallel to the SA or TS, in accordance with the “worst-case scenario” for graft testing. We first applied a preload of 5 to 20 N for 10 cycles to reduce any tissue hysteresis.…”

Section: Methodsmentioning

confidence: 99%

“… 17 , 18 , 40 , 42 Biomechanical studies have demonstrated that the medial patellofemoral ligament (MPFL) is the primary soft tissue that prevents lateral patellar displacement. 1 , 2 , 8 , 13 , 37 Recently, MPFL reconstruction has gained attention because it has yielded good results in clinical trials involving patients in whom nonoperative treatment for recurrent patellar instability has failed. §…”

mentioning

confidence: 99%

“…17,18,40,42 Biomechanical studies have demonstrated that the medial patellofemoral ligament (MPFL) is the primary soft tissue that prevents lateral patellar displacement. 1,2,8,13,37 Recently, MPFL reconstruction has gained attention because it has yielded good results in clinical trials involving patients in whom nonoperative treatment for recurrent patellar instability has failed. § Various techniques have been described in the literature for the fixation of a graft to the patella in MPFL reconstruction, with successful functional and clinical outcomes.…”

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confidence: 99%

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Biomechanical Comparison of 2 Patellar Fixation Techniques in Medial Patellofemoral Ligament Reconstruction: Transosseous Sutures vs Suture Anchors

Zhao

Zhang

2021

Orthopaedic Journal of Sports Medicine

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Background: Multiple techniques for fixing a graft to the patella in medial patellofemoral ligament (MPFL) reconstruction have been described; however, no single technique has been shown to be superior to another. Purpose/Hypothesis: The purpose of this study was to compare the biomechanical performance of 2 different patellar fixation techniques: suture anchor (SA) and transosseous suture (TS) fixation. The hypothesis was that there would be no significant differences between the groups in ultimate failure load, stiffness, or elongation. Study Design: Controlled laboratory study. Methods: In this study, a new TS technique was biomechanically compared with the SA technique for MPFL reconstruction using 24 fresh-frozen mature porcine patellae and porcine flexor profundus tendons. The specimens were randomized into 2 groups undergoing MPFL reconstruction using either the SA technique or the TS technique (n = 12 per group). Fixation with TS was completed using 3 No. 2 UltraBraid sutures and three 2-mm transosseous tunnels. SA reconstruction was completed using 2 parallel 3.5-mm titanium SAs with 2 No. 2 UltraBraid sutures. We preconditioned each graft using a force between 5 and 20 N before cyclic loading. Then, the specimens were biomechanically tested (1000 cycles; 5-100 N; 1 Hz) and loaded under tension at 200 mm/min until failure. The ultimate failure load, stiffness, elongation, and failure mode were recorded for each specimen. The Shapiro-Wilk test and independent t tests were used to assess the data. Results: The TS technique resulted in a significantly higher mean failure load than did the SA technique (496.18 ± 93.15 vs 399.43 ± 105.35 N; P = .03). The TS technique resulted in less stiffness than did the SA technique (55.42 ± 7.92 vs 72.11 ± 10.64 N/mm; P < .01). There was no significant difference between the groups in elongation. None of the graft fixation/patellar complexes failed during cyclic testing in either group. During the load-to-failure test, the most common mode of failure in the SA group was an anchor being pulled out of the bone, whereas that in the TS group was rupture of the suture material. Conclusion: MPFL reconstruction with 3 TSs provided a higher load to failure than did the commonly used fixation method involving SAs.

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“…33 Although there is ongoing discussion of the exact site of ligamentous origin, generally speaking the MPFL runs from the medial femoral epicondyle to the superior one-third or one-half of the medial edge of the patella. 34 On MRI, a normal MPFL is seen as a low signal, linear structure that blends with the vastus medialis obliquus (VMO) muscle, often best depicted on axial images at the distal-most aspect of the VMO. It can be difficult to distinguish between the MPFL and patellar retinaculum, which follows a similar course but is more inferior, attaching to the proximal tibia.…”

Section: Medial Patellofemoral Ligament Normal Imaging Appearancementioning

confidence: 99%

Imaging of Ligamentous Structures within the Knee Includes Much More Than the ACL

Gaetke‐Udager

Yablon

2018

J Knee Surg

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Ligamentous structures of the knee are numerous and complex, including the anterior and posterior cruciate ligaments, medial and lateral collateral ligaments, ligaments of the posteromedial and posterolateral corners, and the anterolateral ligament. Clinical assessment after a knee injury is paramount and can direct both the clinician's choice of imaging study and the radiologist's interpretation. Imaging is crucial in that it provides additional information for diagnosis, management, and surgical planning. Multiple imaging modalities can be used in the evaluation of the knee injuries, with radiographs an important baseline study, magnetic resonance imaging as the best tool for a comprehensive assessment including cruciate ligament evaluation, and ultrasound useful in evaluating superficial structures. Knowledge of both normal and pathological appearances of ligamentous structures, as well as typical injury patterns, is useful not only for radiologists but also for clinicians who manage patients with knee pain.

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The Anatomy of the Medial Patellofemoral Ligament

Cited by 11 publications

References 42 publications

Computed Tomography Imaging Analysis of the MPFL Femoral Footprint Morphology and the Saddle Sulcus: Evaluation of 1094 Knees

Computed Tomography Imaging Analysis of the MPFL Femoral Footprint Morphology and the Saddle Sulcus: Evaluation of 1094 Knees

Biomechanical Comparison of 2 Patellar Fixation Techniques in Medial Patellofemoral Ligament Reconstruction: Transosseous Sutures vs Suture Anchors

Imaging of Ligamentous Structures within the Knee Includes Much More Than the ACL

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