Medial Patellofemoral Ligament, Medial Patellotibial Ligament, and Medial Patellomeniscal Ligament: Anatomic, Histologic, Radiographic, and Biomechanical Study.

Autor:	Hinckel BB; Institute of Orthopedics and Traumatology of the Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil. Electronic address: betinahinckel@me.com., Gobbi RG; Institute of Orthopedics and Traumatology of the Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil., Demange MK; Institute of Orthopedics and Traumatology of the Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil., Pereira CAM; Institute of Orthopedics and Traumatology of the Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil., Pécora JR; Institute of Orthopedics and Traumatology of the Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil., Natalino RJM; Institute of Orthopedics and Traumatology of the Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil., Miyahira L; Institute of Orthopedics and Traumatology of the Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil., Kubota BS; Medical School, University of Sao Paulo, Sao Paulo, Brazil., Camanho GL; Institute of Orthopedics and Traumatology of the Clinical Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2017 Oct; Vol. 33 (10), pp. 1862-1873. Date of Electronic Publication: 2017 Jun 26.
DOI:	10.1016/j.arthro.2017.04.020
Abstrakt:	Purpose: To describe the anatomy (quantitative macroscopic and histologic), radiographic parameters of the insertions, and biomechanical characteristics of the medial ligamentous restrictors of the patella (medial patellofemoral ligament [MPFL], medial patellotibial ligament [MPTL], and medial patellomeniscal ligament [MPML]) in cadaveric knees. Because the MPTL and the MPML are not as well known as the MPFL, they were the focus of this study. Methods: MPFLs, MPTLs, and MPMLs from 9 knees were dissected. Histologic evaluations were conducted. Length, width, and insertion relations with anatomic references were determined. Metallic spheres were introduced into the insertion points of each ligament, and anteroposterior and lateral radiographs were taken. The distances of the insertions from the baselines were measured on radiographs. Tensile tests of the ligaments were performed. Results: All the samples showed dense connective tissue characteristic of ligaments. The MPTL was inserted into the proximal tibia (13.7 mm distal to the joint line) and in the distal end of the patella (3.6 mm proximal to the distal border). The MPTL had a length of 36.4 mm and a width of 7.1 mm. The MPML was inserted into the medial meniscus and distally in the patella (5.7 mm proximal to the distal border). Per radiography, on the anteroposterior view, the tibial insertion of the MPTL was 9.4 mm distal to the joint line and in line with the medial border of the medial spine. On the lateral view, the patellar insertions of the MPTL and MPML were 4.8 and 6.6 mm proximal to its distal border, respectively. The MPTL was stiffer than the MPFL (17.0 N/mm vs 8.0 N/mm, P = .024) and showed less deformation in the maximum tensile strength (8.6 mm vs 19.3 mm, P = .005). Conclusions: The MPTL inserts into the proximal tibia and into the distal pole of the patella. The MPML inserts into the medial meniscus and into the distal pole of the patella. They present with identifiable anatomic and radiographic parameters. Grafts commonly used for ligament reconstructions should be adequate for reconstruction of the MPTL. Clinical Relevance: The study contributes to the anatomic, radiographic, and biomechanical knowledge of the MPTL to improve the outcomes of its reconstruction. (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu