Anatomical study of the medial patello-femoral ligament: landmarks for its surgical reconstruction

Abstract

The aim of this dissection study was to describe the anatomical insertions of the medial patello-femoral ligament (MPFL), and to assess its relationship with surrounding structures to improve its surgical reconstruction. Twelve knees (7 cadavers) were included for the study. Measurements and general features of the MPFL were assessed: lengths, widths and insertions. The MPFL was found in all knees, presenting a triangular shape, and extending from the medial part of the patella to its femoral insertion (its length was of 59±6.6mm), distal to the adductor tubercle. The mean femoral insertion of the MPFL was 7.2±2.7mm proximal and 7.4±4.0mm posterior to the medial femoral epicondyle (MFE). It was also at a mean 11±2.8mm distal and 1.3±2.1mm posterior to the adductor tubercle, and 22±6.4mm anterior to the posterior condyle. We did not find any double-bundle organization on the patellar insertion. The width of the MPFL was 8.8±2.9mm at the femoral insertion, 27±5.9mm at the patellar insertion, and 12±3.1mm in the middle of the MPFL. The vastus medialis obliquus was found to be inserted on the superior part of the MPFL. The adductor tubercle appeared to be a better landmark than the MFE for the femoral tunnel positioning during surgical reconstructions of the MPFL because it was easier to identify and its relationship with the femoral insertion of the MPFL was constant (10mm below).