Medial patellofemoral ligament MRI abnormalities in the setting of MCL injuries: are they clinically relevant?

Abstract

To assess MRI abnormalities of the medial patellofemoral ligament (MPFL) in patients with clinically and MRI-proven superficial medial collateral ligament (sMCL) injuries and determine the clinical significance. High-field strength knee MRI examinations were selected which demonstrated sMCL injuries. These cases were retrospectively reviewed for the presence, location, and severity of MPFL abnormality. The MPFL was divided into a more superior transverse component arising from a femoral attachment (tMPFL), and a broader more inferior oblique decussation component (odMPFL) arising from the anterior margin of the upper sMCL. Chart review was performed to determine the clinical relevance of any MPFL findings. One hundred patients with MCL injury were identified. These included 37 grade I sprains, 33 partial tears, 20 high-grade partial tears, and 10 full thickness tears. Abnormal edema was present at the femoral attachment of the tMPFL in 83%. The odMPFL was abnormal in 90%, most commonly involving the femoral third. No patients had imaging evidence of concurrent lateral patellar dislocation on the initial MRI study. No patients had documented patellofemoral instability at the time of original injury or upon follow-up. No patients required MPFL reconstruction. The MRI appearance of the MPFL is abnormal in the majority of patients with clinically and MRI-documented sMCL sprains and tears. These cases had no evidence of concurrent lateral patellar dislocation on the initial MRI and did not develop patellar instability symptoms.