The role of the medial ligamentous structures on patellar tracking during knee flexion

Philippot, Rémi; Boyer, Bertrand; Testa, Rodolphe; Farizon, Frédéric; Moyen, B.

doi:10.1007/s00167-011-1598-6

Cited by 162 publications

(180 citation statements)

References 20 publications

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“…[4][5][6] The contribution of the secondary restrictors varies among those studies, ranging from 0% to 24% for the MPTL and from 8% to 38% for the MPML. 3,5,6 However, in a more recent study, Philippot et al 2 evaluated the medial ligaments in higher degrees of flexion (from 0 to 90 of flexion), showing that the contributions of the MPTL and MPML to lateral translation restriction increase from 26% in extension to 46% at 90 of flexion. In addition, the influences of the MPTL and MPML at 90 of flexion were 72% in patellar tilt and 92% in patellar rotation.…”

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confidence: 98%

“…1,2 The medial ligaments responsible for maintaining the stability of the patellofemoral joint are the medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), and medial patellomeniscal ligament (MPML).…”

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confidence: 99%

“…There are several studies on the MPFL and its anatomic and biomechanical characteristics [2][3][4][5][6] ; however, little is known about the MPTL and MPML. 2,3,5,6 The first biomechanical studies showed that the MPFL contributes 50% to 60% to medial restriction during initial flexion (between 0 and 30 of flexion).…”

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confidence: 99%

“…2,3,5,6 The first biomechanical studies showed that the MPFL contributes 50% to 60% to medial restriction during initial flexion (between 0 and 30 of flexion). [4][5][6] The contribution of the secondary restrictors varies among those studies, ranging from 0% to 24% for the MPTL and from 8% to 38% for the MPML.…”

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confidence: 99%

“…In addition, the influences of the MPTL and MPML at 90 of flexion were 72% in patellar tilt and 92% in patellar rotation. 2 In the study by Philippot et al, the combined importance of the MPTL and MPML was evaluated rather than the isolated actions of each of these ligaments. In a clinical study, Garth et al 7 observed the presence of clinical and arthroscopic subluxation in patients with isolated MPML lesions with the knee in extension.…”

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confidence: 99%

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Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Hinckel

Gobbi

Demange

et al. 2016

Arthroscopy Techniques

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Although the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts.L ateral patellar dislocation is responsible for 2% to 3% of all knee injuries and is the second leading cause of hemarthrosis. 1,2 The medial ligaments responsible for maintaining the stability of the patellofemoral joint are the medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), and medial patellomeniscal ligament (MPML).There are several studies on the MPFL and its anatomic and biomechanical characteristics 2-6 ; however, little is known about the MPTL and MPML. 2,3,5,6 The first biomechanical studies showed that the MPFL contributes 50% to 60% to medial restriction during initial flexion (between 0 and 30 of flexion). [4][5][6] The contribution of the secondary restrictors varies among those studies, ranging from 0% to 24% for the MPTL and from 8% to 38% for the MPML. 3,5,6 However, in a more recent study, Philippot et al. 2 evaluated the medial ligaments in higher degrees of flexion (from 0 to 90 of flexion), showing that the contributions of the MPTL and MPML to lateral translation restriction increase from 26% in extension to 46% at 90 of flexion. In addition, the influences of the MPTL and MPML at 90 of flexion were 72% in patellar tilt and 92% in patellar rotation. 2 In the study by Philippot et al., the combined importance of the MPTL and MPML was evaluated rather than the isolated actions of each of these ligaments. In a clinical study, Garth et al. 7 observed the presence of clinical and arthroscopic subluxation in patients with isolated MPML lesions with the knee in extension. Thus the MPTL and MPML are important in maintaining normal kinematics of the patellofemoral joint in all ranges of motion, especially at extension and higher degrees of flexion.Usually, surgical treatment involves a combination of reconstruction of the injured MPFL and adjuvant procedures for better alignment and congruence of the patellofemoral joint. Several types of grafts have been described for the reconstruction of the MPFL, and they have shown good results. [8][9][10] In a systematic review of the complications associated with exclusive reconstruction of the MPFL, the observed complication rate was 26.1% of cases. Clinical failure presenting with persistence of

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Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Hinckel

Gobbi

Demange

et al. 2016

Arthroscopy Techniques

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Sectioning the medial patellofemoral ligament alters patellofemoral joint kinematics and contact mechanics

Stephen

Kader

Lumpaopong

et al. 2013

Journal Orthopaedic Research

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Medial patellofemoral ligament (MPFL) disruption may alter patellofemoral joint (PFJ) kinematics and contact mechanics, potentially causing pain and joint degeneration. In this controlled laboratory study, we investigated the hypothesis that MPFL transection would change patellar tracking and PFJ contact pressures and increase the distance between the attachment points of the MPFL. Eight fresh frozen dissected cadaveric knees were mounted in a rig with the quadriceps and ITB loaded to 205 N. An optical tracking system measured joint kinematics, and pressure sensitive film between the patella and trochlea measured PFJ contact pressures. Length patterns of the distance between the femoral and patellar attachments of the MPFL were measured using a suture led to a linear displacement transducer. Measurements were repeated with the MPFL intact and following MPFL transection. A significant increase in the distance between the patellar and femoral MPFL attachment points was noted following transection (p < 0.05). MPFL transection resulted in significantly increased lateral translation and lateral tilt of the patella in early flexion (p < 0.05). Peak and mean medial PFJ contact pressures were significantly reduced and peak lateral contact pressures significantly elevated in early knee flexion following MPFL transection (p < 0.05). MPFL transection resulted in significant alterations to PFJ tracking and contact pressures, which may affect articular cartilage health. The medial patellofemoral ligament (MPFL) is the most important patellofemoral joint (PFJ) stabilizer from 0 to 30˚of knee flexion, contributing 50-60% of the passive resistance to patellar lateral translation.1-4 Patellar dislocation as a consequence of trochlear dysplasia and patella alta were previously highlighted in the literature.5-7 Given its anatomic position, lateral patellar dislocation will almost always damage the MPFL. 8Rupture of the MPFL occurs in 95-100% and injury in 100% of patients suffering patellar dislocation.9-11 PFJ dislocation is linked to the development of abnormal contact stress and joint degeneration. 12,13 This, alongside reports of recurrent instability rates >50% with non-operative management, 14 have perhaps contributed to the recent increase in primary management with operative MPFL repair. 15,16 Given the high levels of patient dissatisfaction following patellar dislocation, the associated incidence of MPFL rupture, and the link to joint degeneration, we hypothesized that MPFL transection would allow the patella to track more laterally than normal, and that this would lead to elevated articular contact pressure on the lateral facet of the PFJ. MATERIALS AND METHODS Specimen PreparationFive male and three female right-sided, fresh-frozen cadaveric knees of mean age 73.5 years (range: 46-88) were obtained from a tissue bank, following approval from a local Research Ethics Committee. Each specimen was cut to 20 cm of femur and 15 cm of tibia, with no deformity apparent on visual inspection. Specimens were stored at À2...

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Elongation and orientation pattern of the medial patellofemoral ligament during lunging

Wang

Kernkamp

et al. 2020

Journal Orthopaedic Research

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Unfavorable clinical outcomes after medial patellofemoral ligament (MPFL) reconstruction, such as early osteoarthritis of the patellofemoral joint, were considered to be associate with tunnel malpositioning. Length change studies have found that small changes in the femoral position can cause great changes in elongation trends. Further studying the MPFL kinematics may help us to understand the consequences of tunnel malpositioning and optimize the reconstruction techniques. Fifteen healthy subjects were studied with a combined computed tomography and biplane fluoroscopic imaging technique during a lunge motion. Five femoral and three patellar attachments were used to simulate different MPFL bundles. Kinematics of MPFL was defined as elongation and orientation changes (i.e., deviation angle and elevation angle). The mean deviation angle was 28.7°(95% confidence interval, 28.0°-29.4°) at full extension and remained nearly unchanged up to 60°of flexion, and increased to 56.5°(54.1°-58.9°) at 110°. The elevation angle decreased linearly from 12.6°(9.3°-15.9°) at full extension to −86.2°(−92.7-79.7°) at 110°of flexion. The MPFL was most stretched anteriorly and laterally relative to femur from full extension to 30°of flexion and remained near isometric beyond 30°. The current study found that proximal and anterior femoral attachments caused excessive lateral stretching of the MPFL at deeper flexion angles. Such abnormal MPFL kinematics may subsequently cause overconstraint and increased cartilage pressures of the medial patellofemoral joint.

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The role of the medial ligamentous structures on patellar tracking during knee flexion

Cited by 162 publications

References 20 publications

Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

Sectioning the medial patellofemoral ligament alters patellofemoral joint kinematics and contact mechanics

Elongation and orientation pattern of the medial patellofemoral ligament during lunging

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