Medial patellofemoral ligament is not the only restraint to lateral patellar displacement
The proximal medial patellar restraints, comprised of the medial patellofemoral ligament and the medial quadriceps tendon femoral ligament, were deemed the primary restraints in lateral patellar translation, according to study results.
In their updated overview of the proximal medial patellar restraints (PMPR), researchers reported on the most current knowledge of medial knee structure anatomy, biomechanics and diagnosis, as well as surgical indications and techniques, according to the study.
“Despite having been called the primary static stabilizer to the patella, the [medial patellofemoral ligament] MPFL has been reported to account for approximately half of the total restraint to lateral patellar displacement,” the authors wrote in the study.
The medial quadriceps tendon femoral ligament accounts for the other half of the proximal restraints and “has gained popularity over the last decade because of pure soft tissue attachments into the extensor mechanism that allow for avoidance of drilling tunnels into the patella during reconstruction,” the authors added.
“Restoring the anatomy of the PMPR during reconstruction is essential to achieve optimal outcomes,” the authors wrote.
Perspective
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The medial patellofemoral complex (MPFC) is indeed “complex.” Our appreciation of its intricate anatomy and biomechanics continues to evolve. The article by Chahla and colleagues provides the foundation by which we may begin to systematically understand the medial stabilizers of the patellofemoral joint. The study nicely integrates data obtained by novel anatomic dissection, cadaveric and in vivo biomechanical study, and imaging technology. The authors provide an evidence-based approach to managing patellofemoral instability that emphasizes precise diagnosis of injured structures and anatomic surgical reconstruction when indicated.
An important take-home message is that while the medial patellofemoral ligament (MPFL) is a main static stabilizer to lateral patella translation, it is not the “only” stabilizer. The MPFC has both proximal (MPFL, MQTFL) and distal (MPTL, MPML) components that contribute differentially to patella stability over the flexion arc. When planning surgery for patella instability, failure to recognize the complex interplay between these and other static and dynamic structures may lead to suboptimal outcome.
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