MPFL: Biomechanics

Dr Julien Chouteau PHU MD PHD, Pr Bernard Moyen

Department of Orthopaedics, Trauma and Sport Medicine, Lyon-Sud Hospital, Pierre-Bnite, France

Efort Instructional Course, Lyon March 2011

MPFL

Medial PatelloFemoral Ligament

LAYERS ON THE MEDIAL ASPECT OF THE KNEE

Superficial Layer: Medial Retinaculum

LAYERS ON THE MEDIAL ASPECT OF THE KNEE

Second (intermediate) layer: Medial PatelloFemoral ligament (MPFL)
(same as MCL)

LAYERS ON THE MEDIAL ASPECT OF THE KNEE

Deepest Layer: Medial PatelloMeniscal ligament (MPML)
MPML Lenght 39.4 3.2mm Width 9.6 1.2mm

LAYERS ON THE MEDIAL ASPECT OF THE KNEE

Deepest Layer : Medial PatelloTibial ligament (MPTL)
MPTL Lenght 54.6 8.4mm Width 21.8 4.4mm

MPFL & MPTL Found in 47%

MPFL ANATOMY
Philippot, Chouteau and al 2009, 23 cadaveric knees

MPFL Always Observed

Lenght : 57.7 5.8mm Width at the femoral insertion: 12.2 2.6mm at the patellar insertion: 24.4 4.8mm

MPFL ANATOMY
Jonction between vastus medialis
obliquus (VMO) and MPFL
Always founded Genuine reflection zone with intertwined MPFL and VMO fibers Length 25.7 6mm

Relationship MPFL / MCL

40% of the knee Strong relationship

between the MPFL and the superficial bundle of the MCL

Ligamentous Arch

Relationship MPFL / MCL

Ligamentous arch
( Smirk et al, Colan et al)

Femoral Insertion
MEDIAL

Tubercle of the great adductor 11.2 mm

HAUT

10.7 mm

Medial Epicondyle

Femoral MPFL Insertion

Femoral Insertion
Philippot, Chouteau and al (Kssta 2009) Orthonormal frame centered on the femoral insertion of the MPFL

F point
Behind and Proximal to the Medial Epicondyle Point

10.7 3.3mm
In Front and Distal to the AT point

11.2+5.9mm

Patellar Insertion
Upper half on the medial edge of the patella Also inserted on the patellar end of the quadriceps tendon Quadriceps tendon and VMO (Colan et al, Smirk et al, Tuxoe et al).

BIOMECHANICS Strength of the MPFL

10 cadaveric specimens (mean age 70 y) Mean failure load 208N

BIOMECHANICS Function of the MPFL

MPFL load during Flexion

Elias (Am J Sport Med 2006) Maximum 20N at 30 flexion Near 0N at 90 flexion

BIOMECHANICS Function of the MPFL

Control of the patellar lateral displacement (%)

Conlan (JBJS Am 1993) 53% Desio (Am J Sport Med 1998) 60% (41-80) Hautamaa (CORR 1998) 50%

BIOMECHANICS Function of the MPFL

From Amis, The Knee 2003 Graph of patellar lateral displacing force at 10
mm displacement,for the intact knee with 175 N quadriceps tension, and after transection of the MPFL.The drop between the two curves shows that the contribution of the MPFL was greatest in the extended knee. *significant difference.

BIOMECHANICS Function of the MPFL

Specific protocol to evaluate the function of the MPFL

BIOMECHANICS Function of the MPFL

Philippot, Chouteau and al
KSSTA 2010

All three bone segments marked so that relative movements of the three segments could be monitored with respect to each other and in the six degrees of freedom

BIOMECHANICS Function of the MPFL

Kinematics on the Healthy knee and after MPFL section

BIOMECHANICS Function of the MPFL

Healthy Knee
Patellar tilt
Almost zero through the first 45 of knee flexion From 45, the patella underwent external tilting which became accentuated towards 90 flexion, reaching a maximum of -3.7 8.9mm with respect to the reference position

BIOMECHANICS Function of the MPFL

Healthy Knee
Patellar Shift
The patella progressively shifted externally to reach, at 90 flexion, a maximum shift of 3.18 9.67 mm with respect to the reference position

BIOMECHANICS Function of the MPFL

Healthy Knee
Patellar Rotation
Through the first 30 of knee flexion, the patella showed medial rotation, reaching a maximum amplitude of 0.8 4.6 at 15 of flexion then a switch to lateral rotation, reaching a maximum of 1.45 6.5 at 90 flexion

BIOMECHANICS Function of the MPFL

Patellar Shift
After section of fibers VMO/MPFL
No statistically significant modification

After section of the MPFL

Statistically significant Increase in lateral patellar shift (maximal in extension and decreasing with flexion)

BIOMECHANICS Function of the MPFL

Patellar Shift
After section of the MPFL
72% increase at full extension, 52% at 90 flexion

BIOMECHANICS Function of the MPFL Lateral Patellar Tilt After section of the MPFL
Statistically significant increase Maximal in extension

BIOMECHANICS Function of the MPFL Lateral Patellar Tilt Control After section of the MPFL
MPFL 76% at full extension and 28% at 90 flexion

BIOMECHANICS Function of the MPFL

Patellar Rotation control

Lateral rotation after MPFL section from extension to 35 flexion

BIOMECHANICS Function of the MPFL

Patellar Rotation control after MPFL section

62% at full extension, 0% from 35

CONCLUSION MPFL
Consistently found in all dissections in the second thickness of the knees medial plane

Main Medial Stabilizer of the Patella from Full Extension to 30 Flexion

THANK YOU
Dr Julien Chouteau PHU MD PHD, Pr Bernard Moyen
Department of Orthopaedics, Trauma and Sport Medicine, Lyon-Sud Hospital, Pierre-Bnite, France Julien.chouteau@chu-lyon.fr