Editorial Commentary: The Medial Patellofemoral Complex Is Composed of the Medial Patellofemoral Ligament and the Medial Quadriceps Tendon–Femoral Ligament: Do We Need to Reconstruct Both? |
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| Institution: | 1. Wake Forest Baptist Health, Winston-Salem, North Carolina, USA;2. Rush University Medical Center, Chicago, Illinois, USA;1. Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio;2. Steadman Clinic, Vail, Colorado U.S.A.;3. Steadman Philippon Research Institute, Vail, Colorado U.S.A.;1. American Hip Institute Research Foundation;2. American Hip Institute, Chicago, Illinois, U.S.A.;1. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.;2. Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.;3. Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.;1. Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A.;2. Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A. |
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| Abstract: | The medial patellofemoral ligament (MPFL) has been known as the primary soft-tissue restraint to lateral patellar translation. More recent anatomic studies have identified additional fibers that extend to the quadriceps tendon (medial quadriceps tendon–femoral ligament MQTFL]), leading to the use of the term “medial patellofemoral complex” (MPFC) to describe the broad and variable attachment of this complex on the patella and quadriceps tendon. Whereas many techniques and outcomes of traditional MPFL reconstruction have been described, fewer reports exist on anatomic MPFC reconstruction to recreate both bundles of this complex. To date, the specific biomechanical roles of, and indications for, reconstruction of the MPFL versus MQTFL fibers have not been defined. One primary benefit of MQTFL reconstruction has been to avoid the risk of patella fracture, which is not obviated in the setting of concurrent patellar fixation when reconstructing both components of the MPFC. The risks and benefits comparing fixation on the patella, quadriceps tendon, or both with anatomic double-bundle reconstruction remain to be determined. Additional studies are needed to understand the differences between reconstructing the proximal and distal fibers of the MPFC with regard to graft length changes and femoral attachment sites, in order to optimally recreate the function of each graft bundle in the surgical treatment of patellar instability. |
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