title: Anatomic study of the attachment of the medial patellofemoral ligament and its characteristic relationships to the vastus intermedius.
abstract: OBJECTIVE
  The aim of this study was to investigate the attachment of the medial patellofemoral ligament (MPFL) using cadaver specimens and establish an anatomic basis for optimal MPFL reconstruction to achieve better patella stability.
  
  
  METHODS
  Sixteen knees of eight cadavers were used in this study. The relationship of the MPFL with quadriceps muscles was investigated from outside after removal of the distal part of the vastus medialis and the rectus femoris and then evaluated from intra-articular side after release of lateral margin of the vastus lateralis muscle, patella and patella tendon.
  
  
  RESULTS
  The proximal fibres of MPFL were mainly attached to the vastus intermedius tendon, without tight adhesion to the vastus medialis. The distal fibres of MPFL were interdigitated with the deep layer of the medial retinaculum that was attached to the medial margin of the patella tendon.
  
  
  CONCLUSIONS
  These findings imply that MPFL, which was directly attached to the vastus intermedius and patella and indirectly continued to the patella tendon, could keep pulling them medially as one unit and consequently make the patella move smoothly on the trochlea during whole movement of the knee. Clinically, dysfunction of both proximal and distal MPFL fibres should be considered in the diagnosis and treatment of patella instability after traumatic patella dislocation. MPFL reconstruction with both fibres has a possibility to lead ideal function of MPFL and better instability of the patella.
authors.affiliation: Section of Joint Reconstruction, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. mochizuki.orj@tmd.ac.jp
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Mochizuki
authors.forename: Akimoto
authors.initials: A
authors.lastname: Nimura
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Tateishi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Muneta
authors.forename: Keiichi
authors.initials: K
authors.lastname: Akita
mesh_terms: D000368:Aged; D002102:Cadaver; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000033:anatomy & histology*; D008297:Male; D057071:Patellofemoral Joint / Q000033:anatomy & histology*; D052097:Quadriceps Muscle / Q000033:anatomy & histology*