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A polygon-shaped complex appearance of medial patellofemoral ligament with dynamic functional insertion based on an outside-in and inside-out dissection technique

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To describe the unclarified characteristics of medial patellofemoral ligament and its relation to neighboring structures.

Methods

Sixteen fresh-frozen human knees were dissected in using outside-in and inside-out combined technique. The patellar side attachment was observed from the inside view and femoral side from outside view.

Results

The medial patellofemoral ligament was described a complex and multiconnected structure. The femoral side included the upper and lower portion, of which the upper portion attached on the femur with mean width 7.5 ± 1.1 mm and its superficial fibers extended to the adductor magnus tendon and the medial gastrocnemius tendon, and of which the lower portion appeared a right-triangle connected to the MCL without bony attachment. From inside view, the patellar attachment consisted of the bony and non-bony parts. The width of bony attachment was measured mean 16.3 ± 3.8 mm, and the non-bony attachment was found attached on the vastus intermedius tendon with mean width 21.7 ± 4.8 mm. The average thickness was 0.4 ± 0.1 mm and the length were inside assessed mean 67.9 ± 6.1 mm.

Conclusion

The medial patellofemoral ligament which dissected a complicated structure with bony and non-bony attachment and multi-connected to neighboring structures on both patella and femur side appears as a polygon-shaped complex structure.

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References

  1. Aframian A, Smith TO, Tennent TD, Cobb JP, Hing CB (2017) Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy. Knee Surg Sports Traumatol Arthrosc 25(12):3755–3772

    Article  Google Scholar 

  2. Ahmad CS, Stein BE, Matuz D, Henry JH (2000) Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases. Am J Sports Med 28(6):804–810

    Article  CAS  Google Scholar 

  3. Aragao 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 (Sao Paulo) 63(4):541–544

    Article  Google Scholar 

  4. Baldwin JL (2009) The anatomy of the medial patellofemoral ligament. Am J Sports Med 37(12):2355–2361

    Article  Google Scholar 

  5. Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11(1):24–31

    CAS  PubMed  Google Scholar 

  6. Davis DK, Fithian DC (2002) Techniques of medial retinacular repair and reconstruction. Clin Orthop Relat Res 402:38–52

    Article  Google Scholar 

  7. Deie M, Ochi M, Sumen Y, Adachi N, Kobayashi K, Yasumoto M (2005) A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13(7):522–528

    Article  Google Scholar 

  8. Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65

    Article  CAS  Google Scholar 

  9. Fink C, Veselko M, Herbort M, Hoser C (2014) Minimally invasive reconstruction of the medial patellofemoral ligament using quadriceps tendon. Arthrosc Tech 3(3):e325-e329

    Article  Google Scholar 

  10. Fujino K, Tajima G, Yan J et al (2015) Morphology of the femoral insertion site of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 23(4):998–1003

    Article  Google Scholar 

  11. Guerrero P, Li X, Patel K, Brown M, Busconi B (2009) Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study. Sports Med Arthrosc Rehabil Ther Technol 1(1):17

    PubMed  PubMed Central  Google Scholar 

  12. Hinckel BB, Gobbi RG, Demange MK et al (2017) Medial patellofemoral ligament, medial patellotibial ligament, and medial patellomeniscal ligament: anatomic, histologic, radiographic, and biomechanical study. Arthroscopy 33(10):1862–1873

    Article  Google Scholar 

  13. Kiran KR, Srikanth IM, Chinnusamy L, Deepti K (2015) Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability: a surgical technique. Indian J Orthop 49(6):630–636

    Article  Google Scholar 

  14. Kyung HS, Kim HJ (2015) Medial patellofemoral ligament reconstruction: a comprehensive review. Knee Surg Relat Res 27(3):133–140

    Article  Google Scholar 

  15. LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Jt Surg Am 89(9):2000–2010

    Google Scholar 

  16. Mochizuki T, Nimura A, Tateishi T, Yamaguchi K, Muneta T, Akita K (2013) Anatomic study of the attachment of the medial patellofemoral ligament and its characteristic relationships to the vastus intermedius. Knee Surg Sports Traumatol Arthrosc 21(2):305–310

    Article  Google Scholar 

  17. Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23(5):260–263

    Article  CAS  Google Scholar 

  18. Nomura E, Horiuchi Y, Inoue M (2002) Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee 9(2):139–143

    Article  CAS  Google Scholar 

  19. 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(7):510–515

    Article  Google Scholar 

  20. 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):7–12

    Article  Google Scholar 

  21. 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(2):331–336

    Article  CAS  Google Scholar 

  22. Placella G, Tei M, Sebastiani E et al (2015) Anatomy of the Medial Patello-Femoral Ligament: a systematic review of the last 20 years literature. Musculoskelet Surg 99(2):93–103

    Article  CAS  Google Scholar 

  23. Placella G, Tei MM, Sebastiani E et al (2014) Shape and size of the medial patellofemoral ligament for the best surgical reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc 22(10):2327–2333

    Article  CAS  Google Scholar 

  24. Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24(1):52–60

    Article  CAS  Google Scholar 

  25. 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 correlation in 14 patients. J Comput Assist Tomogr 25(6):957–962

    Article  CAS  Google Scholar 

  26. Sillanpaa PJ, Maenpaa HM, Mattila VM, Visuri T, Pihlajamaki H (2008) Arthroscopic surgery for primary traumatic patellar dislocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up. Am J Sports Med 36(12):2301–2309

    Article  Google Scholar 

  27. Tanaka MJ (2016) Variability in the patellar attachment of the medial patellofemoral ligament. Arthroscopy 32(8):1667–1670

    Article  Google Scholar 

  28. Toritsuka Y, Horibe S, Hiro-Oka A, Mitsuoka T, Nakamura N (2007) Medial marginal fracture of the patella following patellar dislocation. Knee 14(6):429–433

    Article  Google Scholar 

  29. Tuxoe JI, Teir M, Winge S, Nielsen PL (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10(3):138–140

    Article  Google Scholar 

  30. Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Jt Surg Am 61(1):56–62

    Article  CAS  Google Scholar 

  31. Zhang GY, Zheng L, Feng Y et al (2015) Injury patterns of medial patellofemoral ligament and correlation analysis with articular cartilage lesions of the lateral femoral condyle after acute lateral patellar dislocation in adults: an MRI evaluation. Injury 46(12):2413–2421

    Article  Google Scholar 

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Acknowledgements

The authors thank Robert Smigielski and all the staffs from Carolina Medical Center and CEMED Lab for their support and help through the study. The specimens were supplied by the Carolina Medical Center and CEMED Lab (Warsaw, Poland). Many thanks to Mr. Maciej S’miarowski (maciej.smiarowski@gmail.com) for his taking all photographs and very nice job.

Funding

There was no outside funding or grants received that assisted in this study.

Author information

Authors and Affiliations

  1. Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People’s Republic of China

    Yunshen Ge & Shiyi Chen

  2. Department of Orthopaedic Surgery, Hiroshima University, 734-8551, Kasumi 1-2-3, Minami-ku, Hiroshima, Japan

    Tomohiro Kato

  3. Orthopaedic and Sports Traumatology Department, Carolina Medical Center, ul. Pory 78, 02-757, Warsaw, Poland

    Urszula Zdanowicz & Robert Smigielski

Authors
  1. Yunshen Ge
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  2. Shiyi Chen
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  3. Tomohiro Kato
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  4. Urszula Zdanowicz
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  5. Robert Smigielski
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Corresponding author

Correspondence to Yunshen Ge.

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Conflict of interest

The authors declare no competing financial interest.

Ethical approval

This study has been performed in accordance with the ethical standards concerning investigations on human cadavers in Poland.

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Ge, Y., Chen, S., Kato, T. et al. A polygon-shaped complex appearance of medial patellofemoral ligament with dynamic functional insertion based on an outside-in and inside-out dissection technique. Knee Surg Sports Traumatol Arthrosc 26, 3754–3761 (2018). https://doi.org/10.1007/s00167-018-5013-4

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  • DOI: https://doi.org/10.1007/s00167-018-5013-4

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