Purpose
To report the shape and orientation of the medial patellofemoral complex (MPFC) footprint
on the medial femur and describe the difference between the proximal (medial quadriceps
tendon femoral ligament, MQTFL) and distal (medial patellofemoral ligament, MPFL)
fibers.
Methods
In 20 cadaveric knees, the MPFC footprint on the medial femur was exposed. Images
of the medial femur were analyzed using ImageJ software. The length and width of the MPFC
footprint were described to the nearest 0.1 mm; the angle of its long axis was described
relative to the axis of the femoral shaft (0.1°). The footprint’s most proximal and
distal margins were described in relation to the adductor tubercle and medial epicondyle.
The differences between each were compared using paired t tests.
Results
17 knees from 10 cadavers were included in this study. The MPFC footprint had a length
of 11.7 ± 1.8 mm and a width of 1.7 ± 0.4 mm. The long axis of the footprint was at
an angle 14.6° ± 16.6° anterior to the axis of the femoral shaft. The most proximal
(MQTFL) fibers originated 7.4 ± 3.8 mm anterior and 1.8 ± 4.7 mm distal to the adductor
tubercle and 4.1 ± 2.9 mm posterior and 8.4 ± 5.6 mm proximal to the medial epicondyle.
The most distal (MPFL) fibers originated 4.9 ± 4.2 mm anterior and 12.7 ± 4.3 mm distal
to the adductor tubercle, as well as 7.1 ± 2.4 mm posterior and 0.5 ± 5.6 mm distal
to the medial epicondyle. The distal margin of the femoral MPFC footprint was 10.9
± 1.7 mm distal (p < .001) and 2.6 ± 3.2 mm more posterior (p = .005) than the proximal margin.
Conclusions
The femoral footprint of the MPFC has a length almost 7 times greater than its width,
with the distal margin being 10.9 mm distal and 2.6 mm posterior to the proximal margin.
Clinical Relevance
This differential anatomy within the femoral origin suggests that MPFL and MQTFL reconstruction
may require separate positions of femoral fixation to recreate the anatomy of these
fibers.
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References
- Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment.Knee Surg Sports Traumatol Arthrosc. 2005; 13: 510-515
- Shape and size of the medial patellofemoral ligament for the best surgical reconstruction: a human cadaveric study.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 2327-2333
- The anatomy and reconstruction of the medial patellofemoral ligament.Knee. 2003; 10: 221-227
- Medial quadriceps tendon-femoral ligament: Surgical anatomy and reconstruction technique to prevent patella instability.Arthrosc Tech. 2013; 2: e125-e128
- Functional bundles of the medial patellofemoral ligament.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1511-1516
- Anatomic study of the attachment of the medial patellofemoral ligament and its characteristic relationships to the vastus intermedius.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 305-310
- The anatomic midpoint of the attachment of the medial patellofemoral complex.J Bone Joint Surg Am. 2016; 98: 1199-1205
- Recognition of evolving medial patellofemoral anatomy provides insight for reconstruction.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2537-2550
- Variability in the patellar attachment of the medial patellofemoral ligament.Arthroscopy. 2016; 32: 1667-1670
- Combined reconstruction of the medial patellofemoral ligament (MPFL) and medial quadriceps tendon-femoral ligament (MQTFL) for patellar instability in children and adolescents: Surgical technique and outcomes.J Pediatr Orthop. 2019; 39: e54-e61
- Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: A computational analysis.Am J Sports Med. 2006; 34: 1478-1485
- Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction.Am J Sports Med. 2007; 35: 801-804
- Anatomy of the medial patello-femoral ligament: A systematic review of the last 20 years literature.Musculoskelet Surg. 2015; 99: 93-103
- Quantitative and qualitative analysis of the medial patellar ligaments: An anatomic and radiographic study.Am J Sports Med. 2018; 46: 153-162
- Converting round tendons to flat tendon constructs: Does the preparation process have an influence on the structural properties?.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1561-1567
- Dynamic tracking influenced by anatomy following medial patellofemoral ligament reconstruction: Computational simulation.Knee. 2018; 25: 262-270
- Biomechanical evaluation of medial patello-femoral ligament reconstruction: Comparison between a double-bundle converging tunnels technique versus a single-bundle technique.Musculoskelet Surg. 2016; 100: 103-107
- Anatomical study of the medial patello-femoral ligament: Landmarks for its surgical reconstruction.Surg Radiol Anat. 2014; 36: 733-739
- The medial patellofemoral ligament: Location of femoral attachment and length change patterns resulting from anatomic and nonanatomic attachments.Am J Sports Med. 2012; 40: 1871-1879
- The medial patellofemoral ligament is a dynamic and anisometric structure: An in vivo study on length changes and isometry.Am J Sports Med. 2019; 47: 1645-1653
- 3D computed tomography evaluation of morphological changes in the femoral tunnel after medial patellofemoral ligament reconstruction with hamstring tendon graft for recurrent patellar dislocation.Am J Sports Med. 2017; 45: 1599-1607
- Femoral tunnel widening is associated with tunnel malposition but not with clinical failure after medial patellofemoral ligament reconstruction with a free gracilis tendon graft.Arch Orthop Trauma Surg. 2018; 138: 979-984
- Image processing with ImageJ.Biophotonics Int. 2004; 11: 36-42
Article info
Publication history
Published online: June 19, 2020
Accepted:
June 12,
2020
Received:
December 4,
2019
See commentary on page 3016Footnotes
The author reports no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Back to the Future With the Medial Patellofemoral ComplexArthroscopyVol. 36Issue 12
- PreviewThe desire to better re-create the native anatomy in orthopaedic surgery—and especially knee ligament reconstruction—was an area of great debate and discussion approximately 10 years ago in anterior cruciate ligament (ACL) reconstruction. Our better and more detailed understanding of the anatomy, especially the insertional anatomy, of the ACL fueled the debate over the best surgical technique to maximize function, improve patient outcomes, and reduce long-term morbidity. While these discussions are still ongoing, detailed study of the medial patellofemoral complex (MPFC) anatomy is bringing us “back to the future” with similar discussions on how to best re-create this anatomy.
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