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Recognition of evolving medial patellofemoral anatomy provides insight for reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

A Correction to this article was published on 23 November 2018

This article has been updated

Abstract

Purpose

The scientific literature concerning the anatomy of medial soft-tissue stabilizers of the patella is growing exponentially. Much of the surgical literature has focused on the role of the medial patellofemoral ligament (MPFL) and techniques to reconstruct it, yet our understanding of its anatomy has evolved during the past several years. Given this, we report on the current understanding of medial patellofemoral anatomy and implications for reconstruction.

Methods

Current and historical studies of medial patellar anatomy were reviewed, which include the MPFL and medial quadriceps tendon femoral ligament (MQTFL), as well as that of the distal medial patellar restraints, the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML). In addition to the reported findings, the authors’ anatomic descriptions of each ligament during their dissections were identified and recorded.

Results

Despite the name of the MPFL, which implies that the ligament courses between the femur and patella, recent studies have highlighted the proximal MPFL fibers that attach to the quadriceps tendon, known as the MQTFL. The MPFL and MQTFL have also been referred to as the medial patellofemoral complex, reflecting the variability in anatomical attachment sites. The MPFL accounts for only half of the total restraint to lateral patellar displacement, and the remaining contributions to patellar stability are derived from the combination of the MPTL and MPML, which function primarily in greater degrees of knee flexion.

Conclusion

The understanding of the complexity of the medial patellar stabilizers continues to evolve. Although MPFL reconstruction is gaining wide acceptance as a procedure to treat patellar instability, it is important to recognize the complex and changing understanding of the anatomy of the medial soft-tissue stabilizers and the implications for reconstruction.

Level of evidence

V.

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Change history

  • 23 November 2018

    Unfortunately, the middle name of author was incorrectly published as Jorge A. Chahla instead of Jorge Chahla in the original article.

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Funding

No funding was received in support of this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., Suite 5250, 21287, Baltimore, MD, USA

    Miho J. Tanaka

  2. Cedars-Sinai Kerlan Jobe Institute, Santa Monica, CA, USA

    Jorge Chahla

  3. OrthoIndy Knee Preservation and Cartilage Restoration Center, Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Jack Farr II

  4. The Steadman Clinic, Vail, CO, USA

    Robert F. LaPrade

  5. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Elizabeth A. Arendt

  6. Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Vicente Sanchis-Alfonso

  7. Mountaineer Orthopedic Specialists, LLC, Morgantown, WV, USA

    William R. Post

  8. Orthopedic Associates of Hartford, Farmington, CT, USA

    John P. Fulkerson

  9. Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, CT, USA

    John P. Fulkerson

Authors
  1. Miho J. Tanaka
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  2. Jorge Chahla
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Contributions

MJT participated in study design, drafted the manuscript, and provided figures. JC contributed to manuscript editing and provided figures. RFL contributed to manuscript editing and provided figures. JF participated in manuscript design, structure, and editing. EAA contributed to manuscript concept and editing. VSA contributed to manuscript concept and editing. WRP contributed to manuscript editing. JPF contributed to manuscript concept and editing. All authors read and approved the final manuscript. MJT, JF, EAA, VSA, JPF, and WP are members of the International Patellofemoral Study Group. WP is the chairman of this group. JPF is the president of the Patellofemoral Foundation.

Corresponding author

Correspondence to Miho J. Tanaka.

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Conflict of interest

EAA is a consultant for Smith and Nephew. All other authors declare that they have no competing interests.

Ethical approval

There was no research involving human participants as this was a review paper.

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For this type of study formal consent is not required.

Additional information

The original version of this article was revised: The middle name of author was incorrectly published as Jorge A. Chahla instead of Jorge Chahla in the original article.

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Tanaka, M.J., Chahla, J., Farr, J. et al. Recognition of evolving medial patellofemoral anatomy provides insight for reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 2537–2550 (2019). https://doi.org/10.1007/s00167-018-5266-y

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  • DOI: https://doi.org/10.1007/s00167-018-5266-y

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