title: Medial patellotibial ligament and medial patellomeniscal ligament: anatomy, imaging, biomechanics, and clinical review.
abstract: OBJECTIVE
  The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML.
  
  
  METHODS
  A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML.
  
  
  RESULTS
  The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML. The MPFL is considered the primary restraint to lateral patellar translation, while the latter two are considered secondary restraints. There is robust literature on the anatomical, imaging, and biomechanical characteristics of the MPFL, and also the clinical outcome of its injury and surgical reconstruction; much less is known about the MPTL and MPML. Isolated MPFL reconstruction has good clinical and functional outcomes, with a low failure rate when defined as frank re-dislocation. Complications, including continued episodes of patellar apprehension and subluxation, remain present in most series. In addition, the current literature primarily includes a homogeneous population with few excessive anatomic dysplastic factors. There is lack of knowledge on the role of MPTL and MPML in (potentially) aiding patella stabilization and improving clinical outcomes. Understanding the role of the medial-sided patellar ligaments, in particular the role of the secondary stabilizers, in PF function and injury will aid in this goal.
  
  
  CONCLUSIONS
  MPTL and MPML have consistent basic science literature, as well as favorable clinical outcomes of surgical patellar stabilization with reconstruction of the MPTL. However, there is much heterogeneity among clinical case series and lack of comparative studies to allow clear indication for the role of isolated or combined surgical reconstruction in patellar stabilization. Therefore, this comprehensive review helps understand the current knowledge and the possible applications in the orthopedic clinical practice.
  
  
  METHODS
  V.
authors.affiliation: Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Ave, Columbia, MO, 65212, USA.
authors.forename: Betina Bremer
authors.initials: BB
authors.lastname: Hinckel
authors.affiliation: Orthopedics and Traumatology Institute, University of Sao Paulo, Ovidio Pires de Campos St, 333, Sao Paulo, SP, 5403-010, Brazil.
authors.forename: Riccardo Gomes
authors.initials: RG
authors.lastname: Gobbi
authors.affiliation: Albert Einstein Israelite Hospital, Av Albert Einstein, 627, Building A1, unit 306, Sao Paulo, SP, 05652-900, Brazil.
authors.forename: Camila Cohen
authors.initials: CC
authors.lastname: Kaleka
authors.affiliation: Orthopedics and Traumatology Institute, University of Sao Paulo, Ovidio Pires de Campos St, 333, Sao Paulo, SP, 5403-010, Brazil.
authors.forename: Gilberto Luis
authors.initials: GL
authors.lastname: Camanho
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA. arend001@umn.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Arendt
mesh_terms: D001696:Biomechanical Phenomena; D003952:Diagnostic Imaging; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D008023:Ligaments, Articular / Q000473:pathology*; D019637:Orthopedic Procedures; D010329:Patella / Q000000981:diagnostic imaging* / Q000503:physiopathology; D031222:Patellar Dislocation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D057071:Patellofemoral Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery
keywords: Anatomy; Biomechanics; Clinical outcomes; Imaging; Joint instability; Medial patellofemoral ligament; Medial patellomeniscal ligament; Medial patellotibial ligament; Patellar dislocation