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

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art_HINCKEL_Medial_Patellofemoral_Ligament_Medial_Patellotibial_Ligament_and_Medial_2017.PDF (1.82 MB)
Citações na Scopus
52
Tipo de produção
article
Data de publicação
2017
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
W B SAUNDERS CO-ELSEVIER INC
Autores
Citação
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, v.33, n.10, p.1862-1873, 2017
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
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.
Palavras-chave
URI
https://observatorio.fm.usp.br/handle/OPI/24310
Referências
  1. Arendt EA, 2013, KNEE SURG SPORT TR A, V21, P279, DOI 10.1007/s00167-012-2274-1
  2. Askenberger M, 2014, AM J SPORT MED, V42, P1600, DOI 10.1177/0363546514529639
  3. Aulisa AG, 2012, J ORTHOP SCI, V17, P148, DOI 10.1007/s00776-011-0189-1
  4. Baldwin JL, 2009, AM J SPORT MED, V37, P2355, DOI 10.1177/0363546509339909
  5. Barnett AJ, 2012, KNEE SURG SPORT TR A, V20, P2380, DOI 10.1007/s00167-011-1871-8
  6. Beynnon B D, 1998, Knee Surg Sports Traumatol Arthrosc, V6 Suppl 1, pS70, DOI 10.1007/s001670050226
  7. Bitar AC, 2012, AM J SPORT MED, V40, P114, DOI 10.1177/0363546511423742
  8. Brown Gabriel D, 2008, J Knee Surg, V21, P328
  9. Burks R T, 1998, Am J Knee Surg, V11, P24
  10. CONLAN T, 1993, J BONE JOINT SURG AM, V75A, P682
  11. Criscenti G, 2016, J MECH BEHAV BIOMED, V54, P141, DOI 10.1016/j.jmbbm.2015.09.030
  12. Desio SM, 1998, AM J SPORT MED, V26, P59
  13. Dirim B, 2008, AM J ROENTGENOL, V191, P490, DOI 10.2214/AJR.07.3590
  14. Drez D, 2001, ARTHROSCOPY, V17, P298, DOI 10.1053/jars.2001.21490
  15. Ebied AM, 2012, KNEE SURG SPORT TR A, V20, P926, DOI 10.1007/s00167-011-1659-x
  16. Feller J A, 1993, Knee Surg Sports Traumatol Arthrosc, V1, P184, DOI 10.1007/BF01560202
  17. Galeazzi R., 1922, ARCH ORTOP-MILAN, V38, P315
  18. Garth WP, 2011, J BONE JOINT SURG AM, V93A, P954, DOI 10.2106/JBJS.H.00103
  19. Giordano M, 2012, KNEE SURG SPORT TR A, V20, P1594, DOI 10.1007/s00167-011-1784-6
  20. Gomes JLE, 2004, ARTHROSCOPY, V20, P147, DOI 10.1016/j.arthro.2003.11.006
  21. Grannatt K, 2012, J PEDIATR ORTHOPED, V32, P621, DOI 10.1097/BPO.0b013e318263a230
  22. Grassi Cristiano Antonio, 2013, Rev. bras. ortop., V48, P417, DOI 10.1016/j.rboe.2012.07.012
  23. Herbort M, 2014, KNEE, V21, P1169, DOI 10.1016/j.knee.2014.07.026
  24. Hinckel BB, 2016, ARTHROSC TEC, V5, pE79, DOI 10.1016/j.eats.2015.10.004
  25. Hinckel Betina Bremer, 2016, Rev. bras. ortop., V51, P75, DOI 10.1016/j.rboe.2015.03.012
  26. Kaleka CC, 2017, KNEE SURG SPORT TR A, V25, P144, DOI 10.1007/s00167-016-4322-8
  27. KAPLAN E B, 1957, Bull Hosp Joint Dis, V18, P51
  28. Kim KE, 2014, J BIOMECH, V47, P592, DOI 10.1016/j.jbiomech.2013.11.026
  29. LaCroix AS, 2013, J APPL PHYSIOL, V115, P43, DOI 10.1152/japplphysiol.01449.2012
  30. LANDIS JR, 1977, BIOMETRICS, V33, P159, DOI 10.2307/2529310
  31. Lippe J, 2012, ARTHROSCOPY, V28, P980, DOI 10.1016/j.arthro.2012.01.002
  32. Mountney J, 2005, J BONE JOINT SURG BR, V87B, P36
  33. Nelitz M, 2013, AM J SPORT MED, V41, P58, DOI 10.1177/0363546512463683
  34. Nomura E, 2000, KNEE, V7, P121, DOI 10.1016/S0968-0160(00)00038-7
  35. NOYES FR, 1984, J BONE JOINT SURG AM, V66A, P344
  36. Panagiotopoulos E, 2006, KNEE SURG SPORT TR A, V14, P7, DOI 10.1007/s00167-005-0631-z
  37. Philippot R, 2012, KNEE SURG SPORT TR A, V20, P331, DOI 10.1007/s00167-011-1598-6
  38. Philippot R, 2009, KNEE SURG SPORT TR A, V17, P475, DOI 10.1007/s00167-009-0722-3
  39. Placella G, 2015, Musculoskelet Surg, V99, P93, DOI 10.1007/s12306-014-0335-y
  40. Rillmann P, 1998, Knee Surg Sports Traumatol Arthrosc, V6, P31, DOI 10.1007/s001670050069
  41. Ross MH, 2006, HISTOLOGYDA TEXT ATL
  42. Shah JN, 2012, AM J SPORT MED, V40, P1916, DOI 10.1177/0363546512442330
  43. Sobhy Mohamed Hassan, 2013, Eur J Orthop Surg Traumatol, V23, P465, DOI 10.1007/s00590-012-0999-7
  44. Thawait SK, 2012, SKELETAL RADIOL, V41, P137, DOI 10.1007/s00256-011-1291-3
  45. Tompkins MA, 2015, AM J SPORT MED, V43, P2318, DOI 10.1177/0363546515571544
  46. WARREN LF, 1979, J BONE JOINT SURG AM, V61, P56
  47. Zaffagnini S, 2014, KNEE SURG SPORT TR A, V22, P2491, DOI 10.1007/s00167-013-2751-1

Coleções
Artigos e Materiais de Revistas Científicas - FM/MOT
Artigos e Materiais de Revistas Científicas - HC/IOT
Artigos e Materiais de Revistas Científicas - LIM/41