Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament
Tóm tắt
Aim of this cadaveric biomechanical study was to describe the detailed anatomy of the static medial patellar stabilizers and further determine the role of each of them in preventing lateral patellar dislocation. Eight cadaver knees, after removing the skin and subcutaneous tissues, were used in the study. The medial patellofemoral ligament (MPFL), the medial retinaculum (MR) the medial patellomeniscal ligament (MPML), and the medial patellotibial ligament (MPTL) were dissected. Their origins, insertions, orientations and sizes were recorded. To the medial stabilizers, a tension of 10 pounds was applied, using a tensiometer held in a semicircular device while the knees were kept in 30° of flexion. Then, the previously described ligaments were dissected and the resultant displacement recorded. The most anatomically distinct structure is the MPFL, whose length varies from 45–50 mm, and its width from 10–20 mm at its origin (medial femoral epicondyle) to 20–30 mm at its insertion to the patella. The “meshing” of the MPFL fibers to the fibers of the vastus medialis obliquus (VMO) close to its patellar insertion was the most interesting and very important finding. The contribution of MPFL to medial stability was more than 50%. Of the remaining ligaments, MPML contributes 24% and the MPTL and MR contribute only 13% respectively. The MPFL is the strongest medial static patellar stabilizer. Its contribution to patellar stability against lateral dislocation is far more than 50%, since its meshing with the VMO, shortens its fibers which thus pulls the patella to the medial part of the femoral groove and keeps it in the trochlea during the initial 20°–30° of flexion.
Tài liệu tham khảo
citation_journal_title=Technique and preliminary results. Clin Orthop Rel Res; citation_title=Adductor magnus tenodesis for patellar dislocation; citation_author=VJ Avikainen, RK Nikku, TK Seppanen-Lehmonen; citation_volume=297; citation_publication_date=1993; citation_pages=12-16; citation_id=CR1
citation_journal_title=J Bone Joint Surg; citation_title=The tibial collateral ligament: its bursae, and its relation to the medial meniscus; citation_author=OC Brantigan, AF Voshell; citation_volume=25; citation_issue=A; citation_publication_date=1943; citation_pages=121-131; citation_id=CR2
citation_journal_title=Am J Sports Med; citation_title=Soft tissue restraints to lateral patellar translation in the human knee; citation_author=DM Stephen, BT Robert, BN Kent; citation_volume=26; citation_issue=1; citation_publication_date=1998; citation_pages=59-65; citation_id=CR3
citation_journal_title=Arthroscopy; citation_title=Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation; citation_author=D Drez, TB Edwards, CS Williams; citation_volume=17; citation_issue=3; citation_publication_date=2001; citation_pages=298-306; citation_id=CR4
citation_title=Disorders of the patellofemoral joint; citation_publication_date=1977; citation_id=CR5; citation_author=R Ficat; citation_author=D Hungerford; citation_publisher=Williams & Wilkins
citation_journal_title=Am J Sports Med; citation_title=Acute patellar dislocations. The natural history; citation_author=RJ Hawkins, RH Bell, G Anissete; citation_volume=14; citation_publication_date=1986; citation_pages=117-120; citation_id=CR6
citation_journal_title=J Bone Joint Surg; citation_title=Patellofemoral contact pressure; citation_author=H Huberti, W Hayes; citation_volume=66A; citation_publication_date=1984; citation_pages=715; citation_id=CR7
citation_journal_title=Knee; citation_title=Medial patellofemoral ligament restraint in patellar translation and reconstruction; citation_author=E Nomura, Y Horiuchi, M Kihara; citation_volume=7; citation_issue=4; citation_publication_date=2000; citation_pages=211-215; citation_id=CR8
citation_journal_title=Arthroscopy; citation_title=Surgical technique and rationale for medial patellofemoral ligament reconstruction for recurrent patellar dislocation; citation_author=E Nomura, M Inoue; citation_volume=19; citation_issue=5; citation_publication_date=2003; citation_pages=1-9; citation_id=CR9
citation_journal_title=Am J Sports Med; citation_title=Acute dislocation of the patella. A correlative pathoanatomic study; citation_author=PI Sallay, J Poggi, KP Speer, WE Garrett; citation_volume=24; citation_publication_date=1996; citation_pages=52-60; citation_id=CR10
citation_journal_title=Am J Sports Med; citation_title=The effect of reconstruction of the medial patellofemoral ligament on patellar tracking; citation_author=SH Robert, BT Robert, BN Kent, B Annette; citation_volume=28; citation_issue=3; citation_publication_date=2000; citation_pages=345-349; citation_id=CR11
citation_journal_title=J Bone Joint Surg; citation_title=Lateral release and proximal realignment for patellar subluxation and dislocation; citation_author=G Scuderi, F Cuomo, WN Scott; citation_volume=70; citation_publication_date=1988; citation_pages=856; citation_id=CR12
citation_journal_title=J Bone Joint Surg; citation_title=Acute dislocation of the patella: a prospective review of operative treatment; citation_author=S Vainionpaa, E Laasonen, T Silvennoinen; citation_volume=72B; citation_publication_date=1990; citation_pages=366-369; citation_id=CR13
citation_journal_title=J Bone Joint Surg; citation_author=null Warren; citation_volume=61A; citation_publication_date=1979; citation_pages=56; citation_id=CR14
citation_journal_title=Arthroscopy; citation_title=Clinical evaluation of patients with patellofemoral disorders; citation_author=WR Post; citation_volume=15; citation_issue=8; citation_publication_date=1999; citation_pages=841-851; citation_id=CR15