Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Ave, Columbia, MO, 65212, USA.
Orthopedics and Traumatology Institute, University of Sao Paulo, Ovidio Pires de Campos St, 333, Sao Paulo, SP, 5403-010, Brazil.
Knee Surg Sports Traumatol Arthrosc. 2018 Mar;26(3):685-696. doi: 10.1007/s00167-017-4469-y. Epub 2017 Mar 13.
The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML.
A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML.
The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML. The MPFL is considered the primary restraint to lateral patellar translation, while the latter two are considered secondary restraints. There is robust literature on the anatomical, imaging, and biomechanical characteristics of the MPFL, and also the clinical outcome of its injury and surgical reconstruction; much less is known about the MPTL and MPML. Isolated MPFL reconstruction has good clinical and functional outcomes, with a low failure rate when defined as frank re-dislocation. Complications, including continued episodes of patellar apprehension and subluxation, remain present in most series. In addition, the current literature primarily includes a homogeneous population with few excessive anatomic dysplastic factors. There is lack of knowledge on the role of MPTL and MPML in (potentially) aiding patella stabilization and improving clinical outcomes. Understanding the role of the medial-sided patellar ligaments, in particular the role of the secondary stabilizers, in PF function and injury will aid in this goal.
MPTL and MPML have consistent basic science literature, as well as favorable clinical outcomes of surgical patellar stabilization with reconstruction of the MPTL. However, there is much heterogeneity among clinical case series and lack of comparative studies to allow clear indication for the role of isolated or combined surgical reconstruction in patellar stabilization. Therefore, this comprehensive review helps understand the current knowledge and the possible applications in the orthopedic clinical practice.
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本文旨在回顾内侧髌股韧带（MPTL）和内侧髌半月板韧带（MPML）的解剖学、生物力学和临床数据，以及重点研究内侧髌股韧带（MPFL）但有关于 MPTL 和 MPML 的相关数据的研究。
纳入了专门讨论 MPTL 和/或 MPML 的文献，以及重点研究 MPFL 但有关于 MPTL 和 MPML 的相关数据的研究。
负责维持髌股（PF）关节稳定性的内侧髌韧带包括 MPFL、MPTL 和 MPML。MPFL 被认为是外侧髌骨平移的主要限制，而后两者被认为是次要限制。关于 MPFL 的解剖学、影像学和生物力学特征，以及其损伤和手术重建的临床结果，有大量文献；关于 MPTL 和 MPML 的知识则相对较少。单独的 MPFL 重建具有良好的临床和功能结果，当定义为明显再脱位时，失败率较低。大多数系列仍存在并发症，包括持续性髌骨警觉和半脱位。此外，目前的文献主要包括一个异质性人群，很少有过多的解剖畸形因素。对于 MPTL 和 MPML 在（可能）辅助髌骨稳定和改善临床结果方面的作用，目前还缺乏了解。了解内侧髌骨韧带，特别是次要稳定器在 PF 功能和损伤中的作用，将有助于实现这一目标。
MPTL 和 MPML 有一致的基础科学文献，以及 MPTL 重建的手术髌骨稳定的良好临床结果。然而，临床病例系列之间存在很大的异质性，缺乏比较研究来明确孤立或联合手术重建在髌骨稳定中的作用。因此，这篇全面的综述有助于理解目前的知识和在骨科临床实践中的可能应用。
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