Anatomy and Biomechanics of Medial Patellofemoral Ligament
Regarding the patellar instability and patellar dislocation, several aspects should be considered such as the anatomy of patella and trochlea, the congruency of the joint surfaces, the quadriceps muscle force transition, and surrounding tissue’s mechanica
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Anatomy and Biomechanics of Medial Patellofemoral Ligament Shurong Zhang, Shinya Oka, Ryosuke Kuroda, and Masahiro Kurosaka
Contents 4.1
Medial Patellar Retinacula Complex .......
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4.2 The Anatomical Footprint of MPFL ........ 4.2.1 The Attachment on Patella ........................... 4.2.2 The Attachment on Femur ...........................
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4.3
The Biomechanical Features of MPFL.....
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References ...............................................................
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Regarding the patellar instability and patellar dislocation, several aspects should be considered such as the anatomy of patella and trochlea, the congruency of the joint surfaces, the quadriceps muscle force transition, and surrounding tissue’s mechanical features. The medial patellofemoral ligament (MPFL) is an important mechanical factor in knee stabilization. A conventional concept that the MPFL does not exist in all knees [1, 2] is challenged by recent studies which states that the MPFL is one of the medial retinacula structures extending from medial border of patella to proximal region of femoral epicondyle, contributing most lateral restraining force [3–6]. In the respect of medial patellofemoral anatomy and biomechanics, this article reviews the knowledge of MPFL that is regarded as one of the ligaments maintaining knee stability.
4.1
S. Zhang • S. Oka • R. Kuroda • M. Kurosaka (*) The Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan e-mail: [email protected] A. Gobbi et al. (eds.), The Patellofemoral Joint, DOI 10.1007/978-3-642-54965-6_4, © ISAKOS 2014
Medial Patellar Retinacula Complex
Patella, known as the largest sesamoid bone in the human body, is surrounded by several muscles, tendons, and ligaments. The quadriceps muscles (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius) exist proximal to the patella, generating active restraint force on the patella to stabilize it in axis and medial and lateral direction [7]. The passive restraints are composed of patella ligament that is placed to the distal of patella and medial and lateral retinacular complex, which connect patella to the femur and tibia. 17
S. Zhang et al.
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The lateral retinaculum is a complex structure composed of the deep transverse retinaculum and the superficial oblique retinaculum [8]. The medial retinacular complex is divided into three primary layers [9]. Layer I is the crural fascia, which is wrapped by the sartorius and extended to the tibia in the distal part, while it is wrapped by the medial collateral ligament (MCL) and vastus medialis oblique (VMO) in the proximal part. Layer II is the superficial medial collateral ligament (MCL) and other structures. Layer III is the capsule of the knee joint and the deep MCL. Though it is difficult to identify the borderline from layer I to layer II since some structures fuse toward the same places, MPFL is placed in layer II [5, 10]. The medial patellotibial ligament (MPTL), wrapping over patella and tibia, also exists in the same
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