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. 2017 Dec;25(12):3755-3772.
doi: 10.1007/s00167-016-4272-1. Epub 2016 Sep 8.

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

Arash Aframian  1   2   3 , Toby O Smith  4 , T Duncan Tennent  5   6 , Justin Peter Cobb  7 , Caroline Blanca Hing  5   6
Affiliations

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

Arash Aframian et al. Knee Surg Sports Traumatol Arthrosc. 2017 Dec.

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Methods: A systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016.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.

Keywords: Anatomy; Attachments; Insertion; MPFL; Medial patellofemoral ligament; Origin; Reconstruction.

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Conflict of interest statement

Mr Arash Aframian: None—MD(Res) student. Dr Smith: Grants in primary care research from South Norfolk Clinical Commissioning Group. Grants in patellofemoral instability research from Action Arthritis (Norfolk). Mr Tennent: Consultancy for and royalties from Arthrex. Miss Hing: ORUK (Orthopaedic Research UK) grants. AOUK (Arbeitsgemeinschaft für Osteosynthesefragen UK) grants. St George’s Hospital Charity Grant. Editorial stipend Elsevier. Professor Cobb: Grants in hip surgery with DePuy. Advisory panel for hip preservation for Zimmer Biomet. Consultancy for hip arthroplasty for JRI. Consultancy for knee arthroplasty for Zimmer Biomet. Founder and shareholder for Embody. Founder and shareholder for Orthonika. Multi-centre grant for hip device with JRI. Royalties for knee arthroplasty with MatOrtho. Royalties for transcutaneous limb salvage device with Stanmore Orthopaedics.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of papers searched
Fig. 2
Fig. 2
Diagram summarising the MPFL attachment areas, darker shading represents study concordance. AT adductor tubercle, AMT adductor magnus tendon, GT gastrocnemius tubercle, mGT medial gastrocnemius tendon, sMCL superficial medial collateral ligament, MFE medial femoral condyle
See this image and copyright information in PMC

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