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Descriptive and dynamic study of the medial patellofemoral ligament (MPFL)

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Abstract

Purpose

The goal of this study was to evaluate the anatomy of the medial patellar retinaculum and the medial patellofemoral ligament (MPFL) to provide an anatomical validation of a pediatric reconstruction technique.

Methods

Fifteen knees were dissected to study the MPFL and its relationship with the medial patellar retinaculum and the femoral insertion of the medial collateral ligament (MCL). The distances between the insertions of the MPFL of eight knees, and the patellar insertion of the MPFL and the femoral insertion of the MCL of four knees, were measured during the flexion to evaluate the isometricity of the native and reconstructed MPFL.

Results

The medial patellar retinaculum includes four structures: the fascia, fibrous expansions of the vastus muscles, the MPFL and the medial patellomeniscal ligament. The femoral insertion of the MPFL was located just behind the femoral insertion of the MCL in 12 knees. During flexion, the distance between the insertion on the upper patella and the femoral insertion of the MPFL increased while the distance between the insertion on the lower patella and the femoral insertion of the MPFL decreased. The variation in the distances measured during the flexion was greater between the MPFL insertions (nsup = 6.5 mm, ninf = 6.5 mm) than between the patellar insertion of the MPFL and the femoral insertion of the MCL (n′sup = 2.5 mm, n′inf = 5.75 mm).

Conclusion

The MPFL is not isometric. Even though the results were obtained from knees of elderly specimens, this study demonstrates reconstruction of the MPFL should take into account its anatomy and biomechanical role in the knee.

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Authors and Affiliations

  1. Laboratoire d’Anatomie de la Faculté de Médecine de Nantes, 1, rue Gaston Veil, 44035, Nantes Cedex 01, France

    Cyrille Decante, Céline Salaud, Stéphane Ploteau & Antoine Hamel

  2. Department of Pediatric Orthopedic Surgery, Universitary Hospital Nantes, 7 Quai Moncousu, Nantes Cedex 01, France

    Cyrille Decante, Loïc Geffroy, Antoine Chalopin & Antoine Hamel

Authors
  1. Cyrille Decante
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  2. Loïc Geffroy
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  3. Céline Salaud
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  4. Antoine Chalopin
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  5. Stéphane Ploteau
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  6. Antoine Hamel
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Contributions

CD and LG contributed to study design, realized dissections, contributed to data analysis and draft of the manuscript. CS, AC and SP made critical revisions to the manuscript. AH supervised the study, contributed to analysis and interpretation of data and made critical revisions to the manuscript. All the authors read and approved the final manuscript prior to submission.

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Correspondence to Cyrille Decante.

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The authors declare that they have no conflict of interest.

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Appendix 1

Appendix 1

See Table 1.

Table 1 Summarizing observations and measurements of the descriptive study
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Decante, C., Geffroy, L., Salaud, C. et al. Descriptive and dynamic study of the medial patellofemoral ligament (MPFL). Surg Radiol Anat 41, 763–774 (2019). https://doi.org/10.1007/s00276-019-02234-7

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  • DOI: https://doi.org/10.1007/s00276-019-02234-7

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