AANA Lab Course 910 - Patellofemoral Joint Preservation-Medial Anatomy and Soft Tissue Stabilization-Dr. Miho J. Tanaka, M.D.

Medial Anatomy and Soft Tissue Stabilization-Dr. Miho J. Tanaka, M.D.

Pdf Summary

This lecture by Dr. Miho J. Tanaka focuses on the anatomy and reconstruction of medial patellofemoral structures critical to patellar stability, particularly the medial patellofemoral ligament (MPFL), medial quadriceps tendon-femoral ligament (MQTFL), and medial patellofemoral complex (MPFC). The MPFL is the primary static restraint against lateral patellar translation and is commonly injured during patellar dislocation, necessitating reconstruction in recurrent instability cases. Accurate anatomic reconstruction, especially femoral tunnel positioning, is emphasized to avoid complications, as malposition can increase patellofemoral joint stress.<br /><br />The anatomy is complex and variable: the anterior attachment can include the patella and vastus intermedius tendon, with the MPFC midpoint located near the quadriceps tendon-patella junction. The femoral origin lies near the adductor tubercle and medial epicondyle, with landmarks like Schöttle’s point aiding localization despite noted variability and difficulty.<br /><br />Reconstruction approaches vary, including patellar fixation (avoiding multiple or large holes to reduce fracture risk) or quadriceps tendon fixation to circumvent patellar drilling. Graft options include hamstring autografts, allografts (showing comparable failure rates), and quadriceps tendon grafts. Functional bundles of the MPFL show distinct attachment angles and lengths informing reconstruction strategy.<br /><br />The distal restraints—medial patellomeniscal ligament (MPML) and medial patellotibial ligament (MPTL)—are increasingly recognized for their role in limiting lateral translation at higher knee flexion angles. MPTL reconstruction, sometimes combined with MPFL repair, has shown promising outcomes with relatively low failure rates.<br /><br />Critical surgical principles include precise femoral fixation with fluoroscopic guidance, ensuring isometry with appropriate graft tensioning that allows slack during flexion to prevent overtightening, which can cause joint degeneration. Concurrent pathologies like lateralized tibial tuberosity, patella alta, or trochlear dysplasia should be assessed and addressed to optimize outcomes.<br /><br />In summary, successful medial patellofemoral soft tissue reconstruction relies on understanding anatomical variability, accurate tunnel placement, judicious graft choice and tensioning, and recognition of adjunct procedures that may be necessary to ensure patellar stability and function.

Keywords

medial patellofemoral ligament

MPFL reconstruction

patellar stability

femoral tunnel positioning

medial patellofemoral complex

quadriceps tendon-femoral ligament

patellar dislocation

graft options

medial patellotibial ligament

surgical techniques