Biography: Tanaka is the director of Women’s Sports Medicine Program, Massachusetts General Hospital, and faculty of the Department of Orthopaedic Surgery, Harvard Medical School and MGH Sports Medicine.
Disclosures: Tanaka reports no relevant financial disclosures.LaPrade reports receiving royalties from Arthrex, Ossur and Smith & Nephew; receiving research support from Arthrex, Linvatec, Ossur and Smith & Nephew; being a paid consultant for Ossur and Smith & Nephew; being a board or committee member for the American Orthopaedic Society for Sports Medicine and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; and being on the editorial or governing board of the American Journal of Sports Medicine, the Journal of Experimental Orthopaedics and Knee Surgery, Sports Traumatology, Arthroscopy.
January 27, 2022
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BLOG: Understand the complexities of patellofemoral anatomy and biomechanics

Biography: Tanaka is the director of Women’s Sports Medicine Program, Massachusetts General Hospital, and faculty of the Department of Orthopaedic Surgery, Harvard Medical School and MGH Sports Medicine.
Disclosures: Tanaka reports no relevant financial disclosures.LaPrade reports receiving royalties from Arthrex, Ossur and Smith & Nephew; receiving research support from Arthrex, Linvatec, Ossur and Smith & Nephew; being a paid consultant for Ossur and Smith & Nephew; being a board or committee member for the American Orthopaedic Society for Sports Medicine and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; and being on the editorial or governing board of the American Journal of Sports Medicine, the Journal of Experimental Orthopaedics and Knee Surgery, Sports Traumatology, Arthroscopy.
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The management of patellofemoral instability can be complicated due to the multifactorial nature of this condition.

Abnormalities of multiple factors, including the soft tissue static stabilizers, dynamic stabilizers, osseous geometry of the trochlea and lower extremity alignment, can each contribute with varying severity to a patient’s symptoms. Understanding how to identify and assess these anatomical abnormalities is a critical part of surgical decision-making in the treatment of this disorder. In Module 1 of the Patellofemoral Foundation Online Course, we review and discuss the anatomy and biomechanics of the primary factors in patellar instability.

Miho J. Tanaka
Miho J. Tanaka
Robert F. LaPrade
Robert F. LaPrade

The medial static soft tissue restraints can be thought of in terms of the proximal and distal medial patellar restraints. The proximal medial patellar restraints are comprised of the medial patellofemoral ligament and medial quadriceps tendon femoral ligament (MQTFL), referred to collectively as the medial patellofemoral complex (MPFC). The distal restraints consist of the medial patellomeniscal ligament (MPML) and medial patellotibial ligament (MPTL). In this module, Jorge Chahla, MD, discusses the roles of each component of the soft tissue stabilizers and reviews the anatomical attachment sites, which serve as the basis of our reconstructive techniques.

Trochlear morphology plays a critical role in patellar stability. The patella is stabilized in knee flexion as it engages within the trochlea at approximately 30° of flexion. Trochlear dysplasia refers to an abnormal shape of the trochlear groove, which is insufficiently concave to provide patellar stability. In Module 1, John Elias, PhD, offers his insights into the anatomy of the trochlea and its influence on patellofemoral biomechanics.

Betina Hinckel MD, discusses the roles of lower extremity malalignment, including coronal and rotational alignment, as well as patellar height. Coronal and rotational alignment are important considerations in patellofemoral instability because these can contribute to an increased lateralizing quadriceps vector. Patella alta can cause the patella to not engage in the trochlea until greater degrees of knee flexion, which can decrease stability and patellofemoral contact areas.

Pathologies of the patellofemoral joint are often multifactorial in nature, with contributions related to deficiencies or abnormalities in the soft tissue static stabilizers, including the proximal medial patellar restraints (MPFL, MQTFL) and the distal medial patellar restraints (MPML, MPTL), the osseous geometry of the trochlea and lower extremity alignment. A proper understanding of anatomical abnormalities can help individualize surgical management in the treatment of patellar instability.

Learn more from the experts as we explore each concept in Module 1 at www.elearning.patellofemoral.org.

References:

www.elearning.patellofemoral.org