Medial Patellofemoral Ligament

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- Anatomy and Function: (see medial compartment of knee);
    - medial patellofemoral ligament, a distinct condensation of capsular fibers in coronal plane which originates at the medial epicondyle (adductor
           tubercle and adductor tendon) as well as the MCL;
           - deep fascia and aponeurotic edge of the VMO fuses with the superior border of the medial patellofemoral ligament;
    - it runs transversely (deep to the distal VMO) and inserts on superomedial aspect of patella;
    - helps resist lateral migration of patella (provides 50%-80% of the restraining force to lateral patella dislocation);
    - relation to medial knee ligaments:
           - there are three anatomic layers on the medial side of the knee;
           - superficial layer: investing fascia over the sartorious muscle;
           - middle or second layer: includes the parapatellar retinaculum, MPFL, and superficial MCL;
           - third or deep layer: includes the deep medial collateral and joint capsule;

- Rupture:
    - rupture of medial patellofemoral ligament may follow lateral dislocation of the patella;
    - ligament usually ruptures from its femoral origin;
    - pain and tenderness along the medial retinaculum;
    - need to distinguish from MCL tear;

- Surgical Repair: (for femoral avulsion);
    - MRI is useful to confirm femoral avulsion (versus the occassional patellar avulsion);
    - 4 cm longitudinal incision made anterior to medial epicondyle at the edge of the VMO;
    - MPFL is identified below level of muscle fascia;
    - ligament is re-attached to the femoral using bone anchors; 

- Surgical Reconstruction:
    - gracilis tendon harvest: (see hamstring harvest for ACL reconstruction)
           - tendon is harvested through one inch incision over the pes anserinus;
           - gracilis tendon is exposed and released with a tendon stripper
    - adductor tubercle: 
           - adductor tubercle is exposed and identified at the medial femoral condyle;
           - MPFL insertion point is slightly distal to the tubercle;

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Evaluation of the medial soft tissue restraints of the extensor mechanism of the knee.    T. Conlan et al.  JBJS 75-A. p 682-693. p 1993.

Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children.

The anatomy and reconstruction of the medial patellofemoral ligament.

Anatomy and biomechanics of the medial patellofemoral ligament.

Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation.

Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases.

Medial soft tissue restraints in lateral patellar instability and repair.

Semitendinosus tenodesis for repair of recurrent dislocation of the patella in children.

Techniques of medial retinacular repair and reconstruction.

Medial patellofemoral ligament reconstruction with semitendinosus autograft for chronic patellar instability: a follow-up study.

Technical Errors During Medial Patellofemoral Ligament Reconstruction Could Overload Medial Patellofemoral Cartilage. A Computational Analysis. 

Reconstruction of the Medial Patellofemoral Ligament With Gracilis Tendon Autograft in Transverse Patellar Drill Holes








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