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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2015

01-04-2015 | Knee

Morphology of the femoral insertion site of the medial patellofemoral ligament

Authors: Kotaro Fujino, Goro Tajima, Jun Yan, Youichi Kamei, Moritaka Maruyama, Sanjuro Takeda, Shuhei Kikuchi, Tadashi Shimamura

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2015

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Abstract

Purpose

The purpose of this study was to identify the femoral insertion of the medial patellofemoral ligament (MPFL) and related osseous landmarks.

Methods

A total of 31 unpaired human cadaveric knees were studied. The MPFL was identified, and the site of its femoral insertion was marked. Three-dimensional images were created, and the location and morphology of the femoral insertion of the MPFL and related osseous structures were analyzed.

Results

The MPFL was identified in all knees. The femoral insertion of the MPFL was elliptical in shape, and the mean surface area was 56.5 ± 16.9 mm2. The characteristic features of the femoral insertion of the MPFL could not be identified, but the adductor tubercle was clearly identified in all knees. The centre of the femoral insertion of the MPFL was 10.6 ± 2.5 mm distal to the apex of the adductor tubercle on the long axis of the femur, and the position of the insertion site was consistent in all knees.

Conclusion

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.
Literature
1.
go back to reference Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220CrossRefPubMed Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10:215–220CrossRefPubMed
2.
go back to reference Aragäo JA, Reis FP, de Vasconcelos DP, Feitosa VL, Nunes MA (2008) Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadavers. Clinics 63:541–544CrossRefPubMedCentralPubMed Aragäo JA, Reis FP, de Vasconcelos DP, Feitosa VL, Nunes MA (2008) Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadavers. Clinics 63:541–544CrossRefPubMedCentralPubMed
3.
go back to reference Baldwin JL (2009) The anatomy of the medial patellofemoral ligament. Am J Sports Med 37:2355–2361CrossRefPubMed Baldwin JL (2009) The anatomy of the medial patellofemoral ligament. Am J Sports Med 37:2355–2361CrossRefPubMed
4.
go back to reference Barnett AJ, Howells NR, Burston BJ, Ansari A, Eldridge JD (2012) Radiographic landmarks for tunnel placement in reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 20:2380–2384CrossRefPubMed Barnett AJ, Howells NR, Burston BJ, Ansari A, Eldridge JD (2012) Radiographic landmarks for tunnel placement in reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 20:2380–2384CrossRefPubMed
5.
go back to reference Conlan T, Garth WP, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693PubMed Conlan T, Garth WP, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693PubMed
6.
go back to reference Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefPubMed Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefPubMed
7.
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
8.
go back to reference Farr J, Schepsis A (2006) Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. J Knee Surg 19:307–316CrossRefPubMed Farr J, Schepsis A (2006) Reconstruction of the medial patellofemoral ligament for recurrent patellar instability. J Knee Surg 19:307–316CrossRefPubMed
9.
go back to reference Feller JA, Feagin JA Jr, Garrett WE Jr (1993) The medial patellofemoral ligament revisited: an anatomical study. Knee Surg Sports Traumatol Arthrosc 1:184–186CrossRefPubMed Feller JA, Feagin JA Jr, Garrett WE Jr (1993) The medial patellofemoral ligament revisited: an anatomical study. Knee Surg Sports Traumatol Arthrosc 1:184–186CrossRefPubMed
10.
go back to reference Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121CrossRefPubMed Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121CrossRefPubMed
11.
go back to reference Gelaude F, Vander Sloten J, Lauwers B (2008) Accuracy assessment of CT-based outer surface femur meshes. Comput Aided Surg 13:188–199CrossRefPubMed Gelaude F, Vander Sloten J, Lauwers B (2008) Accuracy assessment of CT-based outer surface femur meshes. Comput Aided Surg 13:188–199CrossRefPubMed
12.
go back to reference Hawkins RJ, Bell RH, Anisette G (1986) Acute patellar dislocations. The natural history. Am J Sports Med 14:117–120CrossRefPubMed Hawkins RJ, Bell RH, Anisette G (1986) Acute patellar dislocations. The natural history. Am J Sports Med 14:117–120CrossRefPubMed
13.
go back to reference Higuchi T, Arai Y, Takamiya H, Miyamoto T, Tokunaga D, Kubo T (2010) An analysis of the medial patellofemoral ligament length change pattern using open-MRI. Knee Surg Sports Traumatol Arthrosc 18:1470–1475CrossRefPubMed Higuchi T, Arai Y, Takamiya H, Miyamoto T, Tokunaga D, Kubo T (2010) An analysis of the medial patellofemoral ligament length change pattern using open-MRI. Knee Surg Sports Traumatol Arthrosc 18:1470–1475CrossRefPubMed
14.
go back to reference Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW (2011) Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 39:1444–1449CrossRefPubMed Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW (2011) Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 39:1444–1449CrossRefPubMed
15.
go back to reference LaPrade RF, Engerbretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89:2000–2010CrossRefPubMed LaPrade RF, Engerbretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Joint Surg Am 89:2000–2010CrossRefPubMed
16.
go back to reference Maenpaa H, Lento M (1997) Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med 25:213–217CrossRefPubMed Maenpaa H, Lento M (1997) Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med 25:213–217CrossRefPubMed
17.
go back to reference Nakagawa K, Wada Y, Minamide M, Tsuchiya A, Moriya H (2002) Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella. J Bone Joint Surg Br 84:861–864CrossRefPubMed Nakagawa K, Wada Y, Minamide M, Tsuchiya A, Moriya H (2002) Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella. J Bone Joint Surg Br 84:861–864CrossRefPubMed
18.
go back to reference Nelitz M, Reichel H, Dornacher D (2012) Anatomical reconstruction of the medial patellofemoral ligament in children with open growth-plates. Arch Orthop Trauma Surg 132:1647–1651CrossRefPubMed Nelitz M, Reichel H, Dornacher D (2012) Anatomical reconstruction of the medial patellofemoral ligament in children with open growth-plates. Arch Orthop Trauma Surg 132:1647–1651CrossRefPubMed
19.
go back to reference Nelitz M, Dornacher D, Dreyhaupt J, Reichel H, Lippacher S (2011) The relation of the distal femoral physis and the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 19:2067–2071CrossRefPubMed Nelitz M, Dornacher D, Dreyhaupt J, Reichel H, Lippacher S (2011) The relation of the distal femoral physis and the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 19:2067–2071CrossRefPubMed
20.
go back to reference Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7:121–127CrossRefPubMed Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7:121–127CrossRefPubMed
21.
go back to reference Nomura E, Inoue M, Osada N (2005) Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 13:510–515CrossRefPubMed Nomura E, Inoue M, Osada N (2005) Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 13:510–515CrossRefPubMed
22.
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 4:7–12CrossRef 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 4:7–12CrossRef
23.
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
24.
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
25.
go back to reference Redfern J, Kamath G, Burks R (2010) Anatomical confirmation of the use of radiographic landmarks in medial patellofemoral ligament reconstruction. Am J Sports Med 38:293–297CrossRefPubMed Redfern J, Kamath G, Burks R (2010) Anatomical confirmation of the use of radiographic landmarks in medial patellofemoral ligament reconstruction. Am J Sports Med 38:293–297CrossRefPubMed
26.
go back to reference Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella: a correlative pathoanatomic study. Am J Sports Med 24:52–60CrossRefPubMed Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella: a correlative pathoanatomic study. Am J Sports Med 24:52–60CrossRefPubMed
27.
go back to reference Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG (2001) Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correction in 14 patients. J Comput Assist Tomogr 25:957–962CrossRefPubMed Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG (2001) Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correction in 14 patients. J Comput Assist Tomogr 25:957–962CrossRefPubMed
28.
go back to reference Sauli P (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 90:463–470CrossRef Sauli P (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 90:463–470CrossRef
29.
go back to reference Schottle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35:801–804CrossRefPubMed Schottle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35:801–804CrossRefPubMed
30.
go back to reference Schottle PB, Schmeling A, Romeo J, Weiler A (2009) Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 129:305–309CrossRefPubMed Schottle PB, Schmeling A, Romeo J, Weiler A (2009) Anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 129:305–309CrossRefPubMed
31.
go back to reference Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10:221–227CrossRefPubMed Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10:221–227CrossRefPubMed
32.
go back to reference Steensen RN, Dopirak RM, McDonald WG 3rd (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32:1509–1513CrossRefPubMed Steensen RN, Dopirak RM, McDonald WG 3rd (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32:1509–1513CrossRefPubMed
33.
go back to reference Stephen JM, Lumpaopong P, Deehan DJ, Kader D, Amis AA (2012) The medial patellofemoral ligament: location of femoral attachment and length change patterns resulting from anatomic and nonanatomic attachments. Am J Sports Med 40:1871–1879CrossRefPubMed Stephen JM, Lumpaopong P, Deehan DJ, Kader D, Amis AA (2012) The medial patellofemoral ligament: location of femoral attachment and length change patterns resulting from anatomic and nonanatomic attachments. Am J Sports Med 40:1871–1879CrossRefPubMed
34.
go back to reference Tajima G, Nozaki M, Iriuchishima T, Ingham SJ, Shen W, Smolinski P, Fu FH (2009) Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am 91:859–866CrossRefPubMed Tajima G, Nozaki M, Iriuchishima T, Ingham SJ, Shen W, Smolinski P, Fu FH (2009) Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am 91:859–866CrossRefPubMed
35.
go back to reference Tateishi T, Tsuchiya M, Motosugi N, Asahina S, Ikeda H, Cho S, Muneta T (2011) Graft length change and radiographic assessment of femoral drill hole position for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19:400–407CrossRefPubMed Tateishi T, Tsuchiya M, Motosugi N, Asahina S, Ikeda H, Cho S, Muneta T (2011) Graft length change and radiographic assessment of femoral drill hole position for medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19:400–407CrossRefPubMed
36.
go back to reference Tuxoe JI, Teir M, Nielsen PL (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10:138–140CrossRefPubMed Tuxoe JI, Teir M, Nielsen PL (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10:138–140CrossRefPubMed
37.
go back to reference Victor J, Wong P, Witvrouw E, Sloten JV, Bellemans J (2009) How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee? Am J Sports Med 37:2028–2036CrossRefPubMed Victor J, Wong P, Witvrouw E, Sloten JV, Bellemans J (2009) How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee? Am J Sports Med 37:2028–2036CrossRefPubMed
38.
go back to reference Yercan HS, Erkan S, Okcu G, Ozalp RT (2011) A novel technique for reconstruction of the medial patellofemoral ligament in skeletally immature patients. Arch Orthop Trauma Surg 13:1059–1065CrossRef Yercan HS, Erkan S, Okcu G, Ozalp RT (2011) A novel technique for reconstruction of the medial patellofemoral ligament in skeletally immature patients. Arch Orthop Trauma Surg 13:1059–1065CrossRef
39.
go back to reference Yoo YS, Chang HG, Seo YJ, Byun JC, Lee GK, Im H, Song SY (2012) Changes in the length of the medial patellofemoral ligament: an in vivo analysis using 3-dimensional computed tomography. Am J Sports Med 40:2142–2148CrossRefPubMed Yoo YS, Chang HG, Seo YJ, Byun JC, Lee GK, Im H, Song SY (2012) Changes in the length of the medial patellofemoral ligament: an in vivo analysis using 3-dimensional computed tomography. Am J Sports Med 40:2142–2148CrossRefPubMed
Metadata
Title
Morphology of the femoral insertion site of the medial patellofemoral ligament
Authors
Kotaro Fujino
Goro Tajima
Jun Yan
Youichi Kamei
Moritaka Maruyama
Sanjuro Takeda
Shuhei Kikuchi
Tadashi Shimamura
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2797-0

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