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The Anatomic Midpoint of the Anterior Attachment of the Medial Patellofemoral Complex

      Introduction

      The reconstruction of the medial patellofemoral ligament (MPFL) and medial quadriceps tendon femoral ligament (MQTFL) has been described in the treatment of patellar instability. The purpose of this study was to identify and describe the anatomic midpoint of the anterior attachment of the combined MPFL and MQTFL (termed the medial patellofemoral complex [MPFC]).

      Methods

      Photographs of 31 cadaveric knee dissections were available for computer-assisted analysis. Using AutoCAD software, a bisecting line was created to identify the midpoint of the MPFC attachment. An anatomic reference point was identified at the intersection of the line along the medial border of the quadriceps tendon and the superior articular border of the patella (P1), and the distance to the midpoint was calculated on the basis of the patellar articular length (PAL).

      Results

      Of the 31 cadaveric knee photographs, 25 had appropriate quality and landmarks for digital analysis. Of these 25 knees, 22 had MPFL and MQTFL fibers, 2 had MQTFL fibers only, and 1 had MPFL fibers only. The midpoint of the MPFC was 3.2 ± 5.9 mm (9.0% ± 16.4% PAL) proximal to P1. After exclusion of the 2 knees with MQTFL fibers only, the MPFC midpoint was 1.9 ± 3.1 mm (5.3% ± 8.6% PAL) proximal to P1. In all knees, the anatomic midpoint of the MPFC was at or proximal to the level of P1.

      Conclusion

      In our anatomic study, the midpoint of the MPFC was found to be at or proximal to the junction of the medial border of the quadriceps tendon and superior pole of the patella. Given the risk of patellar fracture after traditional MPFL reconstruction, further consideration should be given to the analogous MQTFL reconstruction as a potentially safer and more anatomic alternative in the treatment of patellar instability.