Placella G, Tei M M, Sebastiani E, Criscenti G, Speziali A, Mazzola C, Georgoulis A, Cerulli G
Istituto di Ricerca Traslazionale per l'Apparato Locomotore, Nicola Cerulli - Let People Move RI, Arezzo-Perugia, Italy,
Knee Surg Sports Traumatol Arthrosc. 2014 Oct;22(10):2327-33. doi: 10.1007/s00167-014-3207-y. Epub 2014 Aug 17.
The aim of this study was to investigate the shape and the attachments of the medial patellofemoral ligament (MPFL) in cadaver specimens to determine an anatomical basis for the best MPFL reconstruction.
Twenty fresh-frozen knees were used. Dissection protocol implied performing dissections from within the knee joint. We investigated the shape and the attachments between the MPFL and the quadriceps tendon, the patellar and femur insertions, and all the other relationships with the medial soft tissues of the knee.
The distal fibers of MPFL were interdigitated with the deep layer of the medial retinaculum. All isolated ligament had a sail-like shape with the patellar side bigger than the femoral side. The femoral insertion, distinct both from medial epicondyle and adductor tubercle, was located at 9.5 mm (range 4-22) distal and anterior respect to adductor tubercle and proximal and posterior to epicondyle. The medial third of the thickness of patella was involved in the insertion. The proximal third of the patella is always involved in the MPFL attachment; in 45% of the cases, it was extended to the medial third and in one case, an extension at the distal third was found. Additionally in 35% (7 cases), it extended to the quadriceps tendon and it were inconstantly attached at the vastus medialis obliques (VMO) tendon and at the vastus intermedius (VI) tendon in an aponeurotic structure.
The MPFL is a distinct structure that goes from patella to femur with a sail-like shape; its patellar insertion, that mostly occur via an aponeurosis tissue with VMO and VI, is at the proximal third of the patella but it may extend in some cases to the medial third patella or to the quadriceps tendon, or very rarely to the distal third of the patella. In the femoral side, the MPFL is inserted in its own site, in most cases distinct both from epicondyle and adductor tubercle, located on average at a 9.5 mm distance distally and anteriorly in respect to the adductor tubercle. Its lower margin was difficult to define. Given the importance of this structure, it must be reconstructed as anatomically as possible in its insertion and in its shape. Many attempts have been made to make functional reconstructions with less than excellent results.
本研究旨在探究尸体标本中髌股内侧韧带（MPFL）的形态及附着情况，以确定最佳MPFL重建的解剖学基础。
使用20个新鲜冷冻膝关节。解剖方案包括从膝关节内部进行解剖。我们研究了MPFL与股四头肌肌腱、髌骨和股骨附着点之间的形态及附着情况，以及与膝关节内侧软组织的所有其他关系。
MPFL的远端纤维与内侧支持带深层相互交错。所有分离出的韧带呈帆状，髌骨侧大于股骨侧。股骨附着点与内侧髁和内收肌结节不同，位于内收肌结节远端和前方9.5毫米（范围4 - 22毫米）处，内侧髁近端和后方。髌骨厚度的内侧三分之一参与附着。髌骨近端三分之一总是参与MPFL附着；45%的病例中，附着延伸至内侧三分之一，1例中发现延伸至远端三分之一。此外，35%（7例）中，它延伸至股四头肌肌腱，并在腱膜结构中不恒定地附着于股内侧斜肌（VMO）肌腱和股中间肌（VI）肌腱。
MPFL是一种独特的结构，从髌骨到股骨呈帆状；其髌骨附着点大多通过与VMO和VI的腱膜组织发生，位于髌骨近端三分之一，但在某些情况下可能延伸至髌骨内侧三分之一或股四头肌肌腱，或非常罕见地延伸至髌骨远端三分之一。在股骨侧，MPFL附着于其自身位置，大多数情况下与髁和内收肌结节不同，相对于内收肌结节平均位于远端和前方9.5毫米处。其下缘难以界定。鉴于该结构的重要性，必须在其附着点和形态上尽可能按解剖学方式重建。已经进行了许多功能性重建尝试，但结果并不理想。
