J Korean Orthop Assoc.  2011 Dec;46(6):443-450.

Anatomical Reconstruction of the Medial Patellofemoral Ligament: Development of a Novel Procedure Based on Anatomical Dissection

• Lee HS
• Choi JY
• Ha JK
• Lee YS
• Yoo JH
• Kim MK
• Kim JG

Abstract

This paper reports a novel method for reconstructing the medial patellofemoral ligament (MPFL) using hamstring tendon autografts, based on the results of an anatomical study by cadaveric dissection. Five fresh frozen cadaveric knees were studied. MPFL was found present in all cases, and the average length was 54 mm (49.6-59.3 mm). The shape of the MPFL was triangular wherein the femoral attachment was narrow and the patellar attachment was relatively broad. The MPFL was less stiff and a weaker structure compared to the other ligaments. This study could refl ect a novel surgical technique for the MPFL reconstruction with its anatomical and biomechanical properties. The study population comprises of 9 patients (5 males and 4 females) who underwent primary MPFL reconstruction at our clinic between April 2008 and February 2010. The mean follow-up period was 17.6 months. The Kujala score improved signifi cantly from 51.1 points to 81.4 points (p<0.001), the Lysholm score improved signifi cantly from 47.8 points to 84.9 points (p<0.001) and the Tegner activity level improved signifi cantly from 2.9 to 5.1 (p<0.001). There was no case of recurrent dislocation and complications according to the short term follow-up results. Our novel soft tissue fixation method using double bundle reconstruction with hamstring tendon autografts would not only be an anatomic reconstruction but also would be effective for reconstruction of the MPFL.

Keyword

medial patellofemoral ligament; anatomy; patellar dislocation; reconstruction

MeSH Terms

Cadaver
Dislocations
Follow-Up Studies
Humans
Knee
Ligaments
Male
Patellar Dislocation
Tendons
Tissue Fixation

Figure

• 

  Figure 1 This photograph of the isolated medial patellofemoral ligament shows the femoral and patellar attachment sites of the MPFL and the anatomical relationship of medial knee structures. MPFL, medial patellofemoral ligament; sMCL, superficial medial collateral ligament; VMO, vastus medialis obliquus.

• 

  Figure 2 Schematic drawings show measurement parameters in the anatomical dissection study. A, length of patella; B, width of patella; C, distance from the superior pole of patella to the upper border of medial patellofemoral ligament; D, length of patellar insertion of medial patellofemoral ligament; E, distance from lower border of medial patellofemoral ligament to inferior pole of patella; F, length of femoral insertion of medial patellofemoral ligament; G, length of superior border of medial patellofemoral ligament; H, length of inferior border of medial patellofemoral ligament; Ip, thickness of medial patellofemoral ligament at patellar side; If, thickness of medial patellofemoral ligament at femoral side; J, length of patellar insertion of vastus medialis obliquus at medial patellofemoral ligament.

• 

  Figure 3 Our novel procedure of the medial patelofemoral ligament reconstruction. (A) Hamstring autograft is passed under the proximal insertion of superficial medial collateral ligament and suspended. (B) Autograft is passed through the tunnels of patella and tightened. (C) Both ends of autograft were stitched up securely to the soft tissue over the patella.

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  Figure 4 Schematic drawing shows our anatomical reconstruction of medial patellofemoral ligament.

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  Figure 5 A 44-year-old male slipped down and the patella was dislocated 1 month ago. (A) Pre-operative Merchant view: patella tilted laterally. (B) Pre-operative MR image: medial patella-femoral ligament is detached from its femoral insertion (white arrows). (C) Post-operative 8 months Merchant view: patella is reduced in the trochlear groove.

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