Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2017

01-01-2017 | Knee

Cadaveric study of the secondary medial patellar restraints: patellotibial and patellomeniscal ligaments

Authors: Camila Cohen Kaleka, Leandro Jun Aihara, Anderson Rodrigues, Sebastião Ferreira de Medeiros, Victor Marques de Oliveira, Ricardo de Paula Leite Cury

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2017

Login to get access

Abstract

Purpose

To detail the anatomy of the medial patella stabilizers, medial patellotibial (MPTL), and medial patellomeniscal ligaments (MPML), focusing on the points of origin and insertion, length, thickness, width, and fibres orientation to study the frequency of anatomical variations and the anatomy of these ligaments, thereby improving surgical techniques.

Methods

Thirty dissected knees were analysed. A digital caliper was used to measure the length, thickness, and width, as well as the mid-point of the ligaments insertion and the distance from the MPTL insertion to the articular surface of the tibia. The angle of inclination of the ligaments was calculated in the coronal plane. The collected data were tabulated and statistically analysed.

Results

MPTL was present in 90 % as a visible thickening of the deep medial retinaculum and exhibiting only one anatomical variation. The MPML was absent in one of the dissected knees, and one anatomical variation was found. The tilt angle of the ligaments was very similar, with an average of 22.2° ± 7.6° for the MPTL and 24.2° ± 6.6° for the MPML.

Conclusion

The MPTL is a long visible structure of the deep layer of the medial retinaculum, but with a distinct origin and insertion. The MPML is thicker with an angular direction similar to MPTL. The presence of these ligaments in most of the specimens studied suggests that the real anatomical and biomechanical importance of these ligaments should be further investigated because they play a role in the patellar stability.
Literature
1.
go back to reference Balcarek P, Ammon J, Frosch S, Walde TA, Schuttrumpf JP, Ferlemann KG, Lill H, Sturmer KM, Frosch KH (2010) Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy 26:926–935CrossRefPubMed Balcarek P, Ammon J, Frosch S, Walde TA, Schuttrumpf JP, Ferlemann KG, Lill H, Sturmer KM, Frosch KH (2010) Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove distance. Arthroscopy 26:926–935CrossRefPubMed
2.
go back to reference Brown GD, Ahmad CS (2008) Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in skeletally immature patients. J Knee Surg 21:328–332CrossRefPubMed Brown GD, Ahmad CS (2008) Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in skeletally immature patients. J Knee Surg 21:328–332CrossRefPubMed
3.
go back to reference Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11:24–31PubMed Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11:24–31PubMed
4.
go back to reference Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693CrossRefPubMed Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693CrossRefPubMed
5.
go back to reference Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65PubMed Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65PubMed
6.
go back to reference Ebied AM, El-Kholy W (2012) Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability. Knee Surg Sports Traumatol Arthrosc 20:926–932CrossRefPubMed Ebied AM, El-Kholy W (2012) Reconstruction of the medial patello-femoral and patello-tibial ligaments for treatment of patellar instability. Knee Surg Sports Traumatol Arthrosc 20:926–932CrossRefPubMed
7.
go back to reference Galleazzi R (1922) Nuove applicazioni del trapianto muscolare e tendineo. Arch Di Ortop Milano 38:315–323 Galleazzi R (1922) Nuove applicazioni del trapianto muscolare e tendineo. Arch Di Ortop Milano 38:315–323
8.
go back to reference Garth WP Jr, Connor GS, Futch L, Belarmino H (2011) Patellar subluxation at terminal knee extension: isolated deficiency of the medial patellomeniscal ligament. J Bone Joint Surg 93:954–962CrossRefPubMed Garth WP Jr, Connor GS, Futch L, Belarmino H (2011) Patellar subluxation at terminal knee extension: isolated deficiency of the medial patellomeniscal ligament. J Bone Joint Surg 93:954–962CrossRefPubMed
9.
go back to reference Giordano M, Falciglia F, Aulisa AG, Guzzanti V (2012) Patellar dislocation in skeletally immature patients: semitendinosous and gracilis augmentation for combined medial patellofemoral and medial patellotibial ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:1594–1598CrossRefPubMed Giordano M, Falciglia F, Aulisa AG, Guzzanti V (2012) Patellar dislocation in skeletally immature patients: semitendinosous and gracilis augmentation for combined medial patellofemoral and medial patellotibial ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20:1594–1598CrossRefPubMed
10.
go back to reference Grassi CA, Fruheling VM, Abdo JC, De Moura MFA, Namba M, Da Silva JLV et al (2013) Estudo anatômico da inserção dos tendões flexores do joelho. Rev Bras Ortop 48:417–420CrossRef Grassi CA, Fruheling VM, Abdo JC, De Moura MFA, Namba M, Da Silva JLV et al (2013) Estudo anatômico da inserção dos tendões flexores do joelho. Rev Bras Ortop 48:417–420CrossRef
11.
go back to reference Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 349:174–182CrossRef Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 349:174–182CrossRef
12.
go back to reference Kaplan EB (1957) Factors responsible for the static stability of the knee joint. Bull Hosp Jt Dis 18:51–59 Kaplan EB (1957) Factors responsible for the static stability of the knee joint. Bull Hosp Jt Dis 18:51–59
13.
go back to reference LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89:2000–2010PubMed LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89:2000–2010PubMed
14.
go back to reference Marcacci M, Zaffagnini S, Bruni D, Muccioli G, Giordano G, Alvarez P (2010) MPTL (medial patellotibial ligament) reconstruction. In: Zaffagnini S, Dejour D, Arendt E (eds) Patellofemoral pain, instability, and arthritis. Springer, Berlin, pp 185–192CrossRef Marcacci M, Zaffagnini S, Bruni D, Muccioli G, Giordano G, Alvarez P (2010) MPTL (medial patellotibial ligament) reconstruction. In: Zaffagnini S, Dejour D, Arendt E (eds) Patellofemoral pain, instability, and arthritis. Springer, Berlin, pp 185–192CrossRef
15.
go back to reference Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 14(1):7–12CrossRefPubMed Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 14(1):7–12CrossRefPubMed
16.
go back to reference Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P (1987) Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 15:331–341CrossRefPubMed Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P (1987) Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 15:331–341CrossRefPubMed
17.
go back to reference Philippot R, Boyer B, Testa R, Farizon F, Moyen B (2012) The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc 20:331–336CrossRefPubMed Philippot R, Boyer B, Testa R, Farizon F, Moyen B (2012) The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc 20:331–336CrossRefPubMed
18.
go back to reference Philippot R, Chouteau J, Wegrzyn J, Testa R, Fessy MH, Moyen B (2009) Medial patellofemoral ligament anatomy: implications for its surgical reconstruction. Knee Surg Sports Traumatol Arthrosc 17:475–479CrossRefPubMed Philippot R, Chouteau J, Wegrzyn J, Testa R, Fessy MH, Moyen B (2009) Medial patellofemoral ligament anatomy: implications for its surgical reconstruction. Knee Surg Sports Traumatol Arthrosc 17:475–479CrossRefPubMed
19.
go back to reference Placella G, Tei MM, Sebastiani E, Criscenti G, Speziale A, Mazzola C, Georgoulis A, Cerulli G (2014) Shape and size of the medial patellofemoral ligament for the best surgical reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc 22:2327–2333CrossRefPubMed Placella G, Tei MM, Sebastiani E, Criscenti G, Speziale A, Mazzola C, Georgoulis A, Cerulli G (2014) Shape and size of the medial patellofemoral ligament for the best surgical reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc 22:2327–2333CrossRefPubMed
20.
go back to reference Sobhy MH, Mahran MA, Kamel EM (2013) Midterm results of combined patellofemoral and patellotibial ligaments reconstruction in recurrent patellar dislocation. Eur J Orthop Surg Traumatol 23:465–470CrossRefPubMed Sobhy MH, Mahran MA, Kamel EM (2013) Midterm results of combined patellofemoral and patellotibial ligaments reconstruction in recurrent patellar dislocation. Eur J Orthop Surg Traumatol 23:465–470CrossRefPubMed
21.
go back to reference Terry GC (1989) The anatomy of the extensor mechanism. Clin Sports Med 8:163–177PubMed Terry GC (1989) The anatomy of the extensor mechanism. Clin Sports Med 8:163–177PubMed
22.
go back to reference Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg 61:56–62CrossRefPubMed Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg 61:56–62CrossRefPubMed
23.
go back to reference Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Luetzow WF, Vaccari V, Benzi A, Marcacci M (2014) Medial patellotibial ligament (MPTL) reconstruction for patellar instability. Knee Surg Sports Traumatol Arthrosc 22:2491–2498CrossRefPubMed Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Luetzow WF, Vaccari V, Benzi A, Marcacci M (2014) Medial patellotibial ligament (MPTL) reconstruction for patellar instability. Knee Surg Sports Traumatol Arthrosc 22:2491–2498CrossRefPubMed
24.
go back to reference Zhao J, Huangfu X, He Y (2012) The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med 40:1355–1364CrossRefPubMed Zhao J, Huangfu X, He Y (2012) The role of medial retinaculum plication versus medial patellofemoral ligament reconstruction in combined procedures for recurrent patellar instability in adults. Am J Sports Med 40:1355–1364CrossRefPubMed
Metadata
Title
Cadaveric study of the secondary medial patellar restraints: patellotibial and patellomeniscal ligaments
Authors
Camila Cohen Kaleka
Leandro Jun Aihara
Anderson Rodrigues
Sebastião Ferreira de Medeiros
Victor Marques de Oliveira
Ricardo de Paula Leite Cury
Publication date
01-01-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4322-8

Other articles of this Issue 1/2017

Knee Surgery, Sports Traumatology, Arthroscopy 1/2017 Go to the issue