The relationship of the femoral physis and the medial patellofemoral ligament in children: a cadaveric study.
BACKGROUND
Patellar dislocations are common in skeletally immature athletes, and the medial patellofemoral ligament (MPFL) is an important primary restraint to lateral patellar translation. The relationship between the MPFL femoral origin footprint and femoral physis is unclear. The purpose of this study was to evaluate the MPFL femoral origin footprint and its relationship to the femoral physis in skeletally immature anatomic specimens.


METHODS
Six skeletally immature cadaver knee specimens were examined through gross dissection (group A: 1, 11, and 11 mo; and group B: 8, 10, and 11 y). Metallic markers were placed at the center of the MPFL femoral origin footprint. Computed tomography scans for each specimen were analyzed. The MPFL footprint width, and the vertical distances from the center and proximal extent of the MPFL footprint to the medial aspect of the physis were measured.


RESULTS
The mean width of the MPFL femoral origin footprint was 0.70 cm (0.48 to 1.09 cm) and 1.12 cm (1.03 to 1.29 cm) for groups A and B, respectively. The mean distance from the center of the MPFL origin footprint to medial aspect of the distal femoral physis was 0.90 cm (0.52 to 1.30 cm) and 0.40 cm (0.00 to 0.86 cm) distal to the physis for groups A and B, respectively. The mean distance from the proximal extent of the MPFL origin footprint to the medial aspect of the femoral physis was -0.55 cm (-0.28 to -1.03 cm) and 0.16 cm (-0.34 to 0.64 cm) for groups A and B, respectively.


CONCLUSIONS
All subjects were found to have a center of the MPFL origin footprint at or below the physis. The proximal extent of the MPFL origin footprint was found to extend above the physis in the 2 older specimens.


CONCLUSIONS
The relationship of the MPFL origin footprint to the femoral physis in the skeletally immature is not well understood. These dissections may be useful to surgeons performing MPFL reconstructions in skeletally immature patients.
*St. Luke's Sports Medicine, St. Children's Hospital, University of Utah Department of Orthopedics, Boise, ID †Rocky Mountain Youth Sports Medicine Institute, Rocky Mountain Hospital for Children, Denver, CO ‡School of Medicine ∥Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, UT §Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA ¶Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Kevin G
KG
Shea
John D
JD
Polousky
John C
JC
Jacobs
Theodore J
TJ
Ganley
Stephen K
SK
Aoki
Nathan L
NL
Grimm
Shital N
SN
Parikh
D002102:Cadaver; D002648:Child; D004210:Dissection; D005260:Female; D005269:Femur / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006132:Growth Plate / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007719:Knee Joint / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008023:Ligaments, Articular / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008297:Male; D010329:Patella; D014057:Tomography, X-Ray Computed