Shea Kevin G, Styhl Alexandra C, Jacobs John C, Ganley Theodore J, Milewski Matthew D, Cannamela Peter C, Anderson Allen F, Polousky John D
St Luke's Sports Medicine, Boise, Idaho, USA.
University of Utah School of Medicine, Salt Lake City, Utah, USA.
Am J Sports Med. 2016 Nov;44(11):2833-2837. doi: 10.1177/0363546516656366. Epub 2016 Jul 29.
Young athletes sustain patellar dislocations in a variety of sports. The medial patellofemoral ligament (MPFL) is a critical structure that functions as an anatomic checkrein to help prevent lateral patellar dislocation. Reconstruction of this ligament is challenging in patients with open physes because of concerns about iatrogenic damage to the femoral physis.
To evaluate the relationship of the distal femoral physis and the MPFL.
Descriptive laboratory study.
In 15 cadaveric, pediatric knees (age, 7-11 years), markers were placed at the proximal/distal limits of the MPFL femoral attachment and were evaluated with computed tomography. The distance from the MPFL attachment midpoint to the most medial aspect of the distal femoral physis was measured.
The mean femoral width of the MPFL was 8.1 mm (range, 4.3-13.8 mm). The femoral MPFL midpoint was distal to the femoral physis in 11 specimens and proximal to the physis in 4 specimens. The most proximal portion of the MPFL femoral attachment extended above the medial physis in 7, was at the physis in 5, and was below the physis in 3 specimens. One specimen had the entire MPFL femoral attachment above the physis. For knees with the MPFL midpoint above the medial physis, the distance between the center of the MPFL and physis was 3.3 mm (range, 0.3-7.1 mm). For knees with the MPFL below the medial physis, the distance between the center of the MPFL and physis was -6.8 mm (range, -0.7 to -22.0 mm).
The relationship of the femoral attachment of the MPFL and the medial femoral physis shows some anatomic variation. In all cases, the MPFL is close to the medial femoral physis, but the midpoint of the MPFL is at, slightly above, or slightly below the physis.
The relationship of the MPFL femoral attachment footprint to the femoral physis in the skeletally immature patient is not well understood, and access to pediatric cadaveric tissue is very limited. This small series demonstrates that there is considerable variation in the relationship between the MPFL and distal femoral physis. This anatomic information may guide MPFL reconstruction technique in young patients and reduce the risk of iatrogenic physeal arrest on the femur.
年轻运动员在各类运动中会发生髌骨脱位。髌股内侧韧带（MPFL）是一个关键结构，其作用如同解剖学上的控制带，有助于防止髌骨外侧脱位。对于骨骺未闭的患者，重建该韧带具有挑战性，因为担心医源性损伤股骨骨骺。
评估股骨远端骨骺与MPFL的关系。
描述性实验室研究。
在15具尸体的儿童膝关节（年龄7 - 11岁）中，在MPFL股骨附着点的近端/远端界限处放置标记物，并通过计算机断层扫描进行评估。测量从MPFL附着点中点到股骨远端骨骺最内侧的距离。
MPFL的平均股骨宽度为8.1毫米（范围4.3 - 13.8毫米）。MPFL股骨中点在11个标本中位于股骨骨骺远端，在4个标本中位于骨骺近端。MPFL股骨附着点的最近端部分在7个标本中延伸至内侧骨骺上方，在5个标本中位于骨骺处，在3个标本中位于骨骺下方。1个标本的MPFL股骨附着点全部位于骨骺上方。对于MPFL中点位于内侧骨骺上方的膝关节，MPFL中心与骨骺之间的距离为3.3毫米（范围0.3 - 7.1毫米）。对于MPFL位于内侧骨骺下方的膝关节，MPFL中心与骨骺之间的距离为 - 6.8毫米（范围 - 0.7至 - 22.0毫米）。
MPFL股骨附着点与股骨内侧骨骺的关系存在一些解剖学变异。在所有情况下，MPFL都靠近股骨内侧骨骺，但MPFL中点位于骨骺处、略高于骨骺或略低于骨骺。
骨骼未成熟患者中MPFL股骨附着足迹与股骨骨骺的关系尚未完全明确，且获取儿童尸体组织非常有限。这个小样本系列表明，MPFL与股骨远端骨骺之间的关系存在相当大的变异。这些解剖学信息可能指导年轻患者的MPFL重建技术，并降低股骨医源性骨骺阻滞的风险。
