In the JournalsPerspective

Medial patellofemoral ligament originates average of 7 mm distal to distal femoral physis

The medial patellofemoral ligament originates an average of 7 mm distal to the medial distal femoral physis, according to a systematic review performed by researchers at the department of orthopedic surgery at Stanford University.

The researchers analyzed seven articles (298 femurs) that investigated the anatomy of the medial patellofemoral ligament (MPFL) in relation to the medial distal femoral physis in patients with a mean age of 11.7 years, according to the abstract of the review.

Individual study results showed the MPFL originated distal to the medial distal femoral physis in 92.8% of patients, with a range from 3.7 mm proximal to the physis to 10 mm distal to the physis (mean distance of 6.9 mm), according to the abstract.

Researchers qualified that the 7 mm average proximal-to-distal distance is variable in the literature and could differ dependent on study, patient age and sex, they wrote in the abstract.

Bias risk was categorized using the anatomical quality assessment tool, which ultimately determined a low risk of bias, according the abstract. – by Max R. Wursta

 

Disclosures: Sochacki reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

The medial patellofemoral ligament originates an average of 7 mm distal to the medial distal femoral physis, according to a systematic review performed by researchers at the department of orthopedic surgery at Stanford University.

The researchers analyzed seven articles (298 femurs) that investigated the anatomy of the medial patellofemoral ligament (MPFL) in relation to the medial distal femoral physis in patients with a mean age of 11.7 years, according to the abstract of the review.

Individual study results showed the MPFL originated distal to the medial distal femoral physis in 92.8% of patients, with a range from 3.7 mm proximal to the physis to 10 mm distal to the physis (mean distance of 6.9 mm), according to the abstract.

Researchers qualified that the 7 mm average proximal-to-distal distance is variable in the literature and could differ dependent on study, patient age and sex, they wrote in the abstract.

Bias risk was categorized using the anatomical quality assessment tool, which ultimately determined a low risk of bias, according the abstract. – by Max R. Wursta

 

Disclosures: Sochacki reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Michael J. Medvecky

    Michael J. Medvecky

    The study by Sochacki and colleagues provided a systematic review of the existing literature on the anatomic analysis of the origin of the MPFL in relation to the distal femoral physis. The implications of physeal arrest if performing an anatomical MPFL reconstruction has previously led toward non-anatomical reconstructions. The proximity of the adductor tendon and its attachment site at the adductor tubercle has been utilized for fixation of grafts in the skeletally immature but may have altered biomechanical forces due to its proximal and posterior position in relation to the MPFL origin.

    This review identified that the MPFL attachment site is in 93% of specimens an average of 7 mm distal to the distal femoral physis. An additional surgical pearl highlighted in this review was the fact that the distal femoral physis becomes distal to the MPFL origin at a point 10.5 mm lateral to the MPFL attachment site on the medial femur. A direct lateral drilling has the potential for disrupting this physis. They advocate directing the drill distal and anterior in relation to the coronal plane to avoid injury to the distal femoral physis. The benefit of intraoperative fluoroscopy to verify tunnel positioning is highlighted.

    The systematic review gives support to the ability to provide anatomic MPFL reconstruction in the skeletally immature patient. The benefit of an anatomic reconstruction is the potential for a more normal or improved biomechanical environment, enhanced stability and improved tolerance of return to previous activity level. The technical considerations are of high importance to lessen injury to the distal femoral physis that may not been seen from an external, extracortical perspective.

    • Michael J. Medvecky, MD, FAAOS
    • Section chief of sports medicine
      Associate professor
      Department of orthopedics and rehabilitation
      Yale University School of Medicine

    Disclosures: Medvecky reports no relevant financial disclosures.

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