title: Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy.
abstract: OBJECTIVE
  The medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the medial patella. The exact position reported in the literature varies. Understanding the true anatomical origin and insertion of the MPFL is critical to successful reconstruction. The purpose of this systematic review was to determine these locations.
  
  
  METHODS
  A systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016. All papers investigating the anatomy of the MPFL were eligible. Methodological quality was assessed using a modified CASP tool. A narrative analysis approach was adopted to synthesise the findings.
  
  
  RESULTS
  After screening and review of 2045 papers, a total of 67 studies investigating the relevant anatomy were included. From this, the origin appears to be from an area rather than (as previously reported) a single point on the medial femoral condyle. The weighted average length was 56 mm with an 'hourglass' shape, fanning out at both ligament ends.
  
  
  CONCLUSIONS
  The MPFL is an hourglass-shaped structure running from a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. Awareness of anatomy is critical for assessment, anatomical repair and successful surgical patellar stabilisation.
  
  
  METHODS
  Systematic review of anatomical dissections and imaging studies, Level IV.
authors.affiliation: Trauma and Orthopaedics Department, 5th Floor St James' Wing, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK. arash.aframian@gmail.com.|St George's, University of London, London, SW17 0RE, UK. arash.aframian@gmail.com.|Imperial College, London, W6 8RP, UK. arash.aframian@gmail.com.
authors.forename: Arash
authors.identifier: http://orcid.org/0000-0003-0266-3281
authors.initials: A
authors.lastname: Aframian
authors.affiliation: Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
authors.forename: Toby O
authors.initials: TO
authors.lastname: Smith
authors.affiliation: Trauma and Orthopaedics Department, 5th Floor St James' Wing, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.|St George's, University of London, London, SW17 0RE, UK.
authors.forename: T Duncan
authors.initials: TD
authors.lastname: Tennent
authors.affiliation: Imperial College, London, W6 8RP, UK.
authors.forename: Justin Peter
authors.initials: JP
authors.lastname: Cobb
authors.affiliation: Trauma and Orthopaedics Department, 5th Floor St James' Wing, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.|St George's, University of London, London, SW17 0RE, UK.
authors.forename: Caroline Blanca
authors.initials: CB
authors.lastname: Hing
mesh_terms: D016208:Databases, Factual; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D017847:Patellar Ligament / Q000033:anatomy & histology*; D057071:Patellofemoral Joint / Q000502:physiology*
keywords: Anatomy; Attachments; Insertion; MPFL; Medial patellofemoral ligament; Origin; Reconstruction