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08.09.2016 | Knee | Ausgabe 12/2017 Open Access

Knee Surgery, Sports Traumatology, Arthroscopy 12/2017

Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy

Zeitschrift:
Knee Surgery, Sports Traumatology, Arthroscopy > Ausgabe 12/2017
Autoren:
Arash Aframian, Toby O. Smith, T. Duncan Tennent, Justin Peter Cobb, Caroline Blanca Hing

Abstract

Purpose

The medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the medial patella. The exact position reported in the literature varies. Understanding the true anatomical origin and insertion of the MPFL is critical to successful reconstruction. The purpose of this systematic review was to determine these locations.

Methods

A systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016. All papers investigating the anatomy of the MPFL were eligible. Methodological quality was assessed using a modified CASP tool. A narrative analysis approach was adopted to synthesise the findings.

Results

After screening and review of 2045 papers, a total of 67 studies investigating the relevant anatomy were included. From this, the origin appears to be from an area rather than (as previously reported) a single point on the medial femoral condyle. The weighted average length was 56 mm with an ‘hourglass’ shape, fanning out at both ligament ends.

Conclusion

The MPFL is an hourglass-shaped structure running from a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. Awareness of anatomy is critical for assessment, anatomical repair and successful surgical patellar stabilisation.

Level of evidence

Systematic review of anatomical dissections and imaging studies, Level IV.

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