Medial Patellofemoral Anatomy and Surgery

The medial patellofemoral ligament (MPFL) has been long described as the primary static restraint to lateral patellar translation. Advances in the understanding of medial patellofemoral anatomy have led to changes in the nomenclature of this ligament to allow for its anatomic variability. The proximal medial patellar restraints are referred to collectively as the medial patellofemoral complex (MPFC), a broad, fan-shaped structure that comprises the medial patellofemoral ligament (MPFL) and the medial quadriceps-tendon-femoral ligament (MQTFL) attachments. The distal medial patellar restraints comprised the medial patellomeniscal ligament (MPML) and the medial patellotibial ligament (MPTL). These ligamentous structures act as important soft-tissue stabilizers of the patellofemoral joint and are often disrupted in the setting of patellar instability. Reconstruction of these ligamentous restraints has been shown to restore patellar stability, and anatomic reconstruction is critical in recreating the function of the ligament and avoiding complications. This chapter discusses the anatomy and biomechanics of the medial patellar restraints, as well as their relevance to current reconstruction techniques.