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Anatomy of the Medial Patello-Femoral Ligament: a systematic review of the last 20 years literature

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Background

Although many studies have investigated the anatomy of the Medial Patello-Femoral Ligament (MPFL), some studies have even questioned its existence. In the last 20 years, there is a renewed interest on the role of the MPFL in patello-femoral instability. As a result, several studies have been published that describe the anatomy, function and possible surgical reconstruction of the MPFL. Despite the large amount of literature produced, there is still a lack of consensus on what is its real anatomy as there are currently no systematic reviews on this topic.

Purposes

Thus, the aim of this review is to systematically report the results in literature regarding in anatomical papers, the existence, size, insertion sites and relationships of this ligament with the other medial structures of the knee.

Methods

We have systematically analyzed anatomical studies currently available in literature between 1980 and December 2012. The search was carried out on Medline, Embase, Cochrane Library and Google Scholar. We checked reference lists of articles, reviews and textbooks identified by the search strategy for other possible relevant studies.

Results

The outcomes examined are the presence of the ligament, its size (length, width, thickness), and its patellar and femoral insertions. A total of 312 cadaveric knees were included in the 17 studies; the MPFL was identified in 99 % of cases (309).

Conclusions

The consensus is that the MPFL is almost always present in the dissected knees. The size and insertions of the ligament demonstrate great variation between cadavers.

Level of evidence

Systematic review of anatomical study, Level 1.

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References

  1. Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220

    Article  CAS  PubMed  Google Scholar 

  2. Andrikoula S et al (2006) The extensor mechanism of the knee joint: an anatomical study. Knee Surg Sports Traumatol Arthrosc 14(3):214–220

    Article  PubMed  Google Scholar 

  3. Aragão 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 James L (2009) The anatomy of the medial patellofemoral ligament. Am J Sports Med 37(12):2355–2361

    Article  PubMed  Google Scholar 

  5. 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 75:682–693

    CAS  PubMed  Google Scholar 

  6. Desio Stephen M, Burks Robert T, Bachus Kent N (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65

    CAS  PubMed  Google Scholar 

  7. Feller JA, Feagin JA Jr, Garrett WE Jr (1993) The medial patellofemoral ligament revisited: an anatomical study. Knee Surg Sports Traumatol Arthrosc 1:184–186

    Article  CAS  PubMed  Google Scholar 

  8. 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 349:174–182

    Article  PubMed  Google Scholar 

  9. LaPrade RF et al (2007) The anatomy of the medial part of the knee. J Bone Joint Surg 89(9):2000–2010

    Article  PubMed  Google Scholar 

  10. Mochizuki T et al (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  PubMed  Google Scholar 

  11. Nomura E, Horiuchi Y, Kihara M (2000) Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 7(2):121–127

    Article  PubMed  Google Scholar 

  12. 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 Epub 2005 May 13

    Article  PubMed  Google Scholar 

  13. 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 Epub 2005 Jul 7

    Article  PubMed  Google Scholar 

  14. 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. (Epub 2011 Jul 12). doi:10.1007/s00167-011-1598-6

  15. Reider B, Marshall JL, Koslin B, Ring B, Girgis FG (1981) The anterior aspect of the knee joint. J Bone Joint Surg 63:351–356

    CAS  PubMed  Google Scholar 

  16. Schindler OS, Norman Scott W (2011) Basic kinematics and biomechanics of the patello-femoral joint. Acta Orthop Belg 77(4):421–431

    PubMed  Google Scholar 

  17. Sillanpää PJ, Mäenpää HM (2012) First-time patellar dislocation: surgery or conservative treatment? Sports Med Arthrosc 20(3):128–135. doi:10.1097/JSA.0b013e318256bbe5

    Article  PubMed  Google Scholar 

  18. Sillanpää PJ, Peltola E, Mattila VM et al (2009) Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: a mean 7-year nonoperative follow-up study. Am J Sports Med 37:1513–1521

    Article  PubMed  Google Scholar 

  19. Smirk Cameron, Morris Hayden (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10(3):221–227

    Article  PubMed  Google Scholar 

  20. Steensen RN, Dopirak RM, Maurus PB (2005) A simple technique for reconstruction of the medial patellofemoral ligament using a quadriceps tendon graft. Arthroscopy 21:365–370

    Article  PubMed  Google Scholar 

  21. Steensen Robert N, Dopirak Ryan M, McDonald William G (2004) The anatomy and isometry of the medial patellofemoral ligament implications for reconstruction. Am J Sports Med 32(6):1509–1513

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  24. Zaffagnini S, Colle F, Lopomo N, Sharma B, Bignozzi S, Dejour D, Marcacci M (2013) The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc 21(9):2164–2171. (Epub 2012 Nov 24). doi:10.1007/s00167-012-2307-9

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Conflict of interest

Authors wish to confirm that there is no known conflict of interests associated with this publication, and there has been no significant financial support for this work that could have influenced its outcome.

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Correspondence to G. Placella.

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Placella, G., Tei, M., Sebastiani, E. et al. Anatomy of the Medial Patello-Femoral Ligament: a systematic review of the last 20 years literature. Musculoskelet Surg 99, 93–103 (2015). https://doi.org/10.1007/s12306-014-0335-y

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  • DOI: https://doi.org/10.1007/s12306-014-0335-y

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