title: Anatomical confirmation of the use of radiographic landmarks in medial patellofemoral ligament reconstruction.
abstract: BACKGROUND
  A recent study has described radiographic landmarks for femoral insertion of the medial patellofemoral ligament. Clinical relevance and application of these landmarks for surgical reconstruction have yet to be determined.
  
  
  OBJECTIVE
  Radiographic landmarks can be used to accurately determine the femoral insertion of the medial patellofemoral ligament in a percutaneous fluoroscopically guided surgical technique.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  The femoral insertion of the medial patellofemoral ligament was estimated using fluoroscopy in 8 fresh-frozen human cadaveric knees. The knees were dissected and the true anatomical medial patellofemoral ligament femoral insertion was identified. Radiographic markers were placed on both the estimated and anatomical medial patellofemoral ligament and a repeat lateral radiograph was performed. Using imaging software, the distance between the true anatomical insertion and the fluoroscopically determined insertion was calculated. Results All 8 points determined by fluoroscopically guided pin placement averaged less than 4 mm from the anatomical insertion. The radiographic landmark method consistently placed the origin on average 2.5 mm anterior and 0.6 mm distal to the anatomical insertion.
  
  
  CONCLUSIONS
  Radiographic landmarks determined by fluoroscopy can be used to accurately reproduce the femoral insertion of the medial patellofemoral ligament in ligament reconstruction.
  
  
  CONCLUSIONS
  Confirming the use of radiographic landmarks to determine the medial patellofemoral ligament femoral insertion may help to increase accuracy and precision in ligament reconstruction and minimize surgical dissection.
authors.affiliation: Colorado Springs Orthopaedic Group, 3010 N Circle Dr, Suite 100A, Colorado Springs, CO 80909, USA. jcredfern@hotmail.com
authors.forename: John
authors.initials: J
authors.lastname: Redfern
authors.forename: Ganesh
authors.initials: G
authors.lastname: Kamath
authors.forename: Robert
authors.initials: R
authors.lastname: Burks
mesh_terms: D002102:Cadaver; D005260:Female; D005269:Femur / Q000601:surgery*; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D057071:Patellofemoral Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D011857:Radiographic Image Interpretation, Computer-Assisted