Quantifying the Relationship Between the Medial Quadriceps Tendon–Femoral Ligament and Patellar Borders: A Pediatric Cadaveric Study

Danika Baskar; Tyler J. Stavinoha; Mark Sanchez; Anshal Gupta; Sahej D. Randhawa; Matthew S. Rohde; Brian Vuong; Marc A. Tompkins; Theodore J. Ganley; Henry B. Ellis; Philip L. Wilson; Peter D. Fabricant; Curtis VandenBerg; Daniel W. Green; Nicole A. Segovia; Kevin G. Shea

doi:10.1177/03635465221103250

Quantifying the Relationship Between the Medial Quadriceps Tendon–Femoral Ligament and Patellar Borders: A Pediatric Cadaveric Study

Danika Baskar
, Tyler J. Stavinoha
, Mark Sanchez
, Anshal Gupta
, Sahej D. Randhawa
, Matthew S. Rohde
, Brian Vuong
, Marc A. Tompkins
, Theodore J. Ganley
, Henry B. Ellis
, Philip L. Wilson
, Peter D. Fabricant
, Curtis VandenBerg
, Daniel W. Green
, Nicole A. Segovia
, Kevin G. Shea

Orthopaedic Surgery

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

BACKGROUND: The medial patellofemoral complex (MPFC) is a structure composed of the medial quadriceps tendon-femoral ligament (MQTFL) superiorly and the medial patellofemoral ligament (MPFL) inferiorly. The pediatric MPFL anatomy has been well described, but the precise anatomy of the MQTFL has only recently been described and studied in skeletally immature patients.

PURPOSE: To describe the anatomic relationship between the MQTFL and its insertion on the quadriceps tendon and patella in pediatric specimens.

STUDY DESIGN: Descriptive laboratory study.

METHODS: A total of 22 pediatric cadaveric knee specimens were dissected to analyze attachment of the MQTFL to the quadriceps tendon and patella. Dissection was facilitated using lateral parapatellar arthrotomy followed by eversion of the extensor mechanism to evaluate MQTFL fibers from its undersurface.

RESULTS: The mean specimen age was 7.4 years. Specimens were divided based on age into a younger cohort (1-2 years), middle cohort (4-8 years), and older cohort (9-12 years). The quadriceps tendon attachment (QTA) of the MQTFL proximal to the patella extended a median of 5.0 mm in the younger cohort, 11.4 mm in the middle cohort, and 12.0 mm in the older cohort, with significant differences found between the younger and middle cohorts ( P < .047) and the younger and older cohorts ( P < .001). The QTA as a percentage of patellar articular height averaged 44.4% across all specimens. The vertical height of the patella measured a median of 14.0 mm, 22.3 mm, and 27.3 mm in the younger, middle, and older cohorts, respectively.

CONCLUSION: This study expands on the recently described anatomy of the pediatric MPFC to quantify the anatomic relationship between the MQTFL attachment to the quadriceps tendon and patella in a more clinically relevant cohort of donor specimens.

CLINICAL RELEVANCE: As access to pediatric cadaveric tissue is extremely limited, a better understanding of MPFC and MQTFL anatomy will support surgeons in preoperative planning and intraoperative considerations for their approach to MQTFL and MPFL reconstruction. This may facilitate improved anatomic surgical stabilization of the patellofemoral joint in pediatric patients.

Original language	English (US)
Pages (from-to)	2433-2438
Number of pages	6
Journal	American Journal of Sports Medicine
Volume	50
Issue number	9
DOIs	https://doi.org/10.1177/03635465221103250
State	Published - Jul 2022

Bibliographical note

Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: AlloSource donated the cadaveric specimens and nonfinancial research support for this study. T.J.S. has received hospitality payments from Arthrex and support for education from MedInc of Texas and Midsouth Orthopedics. M.A.T. has received hospitality payments from Aesculap Biologics and a grant from DJO. T.J.G. has received support for education from Liberty Surgical and is an associate editor of AJSM. H.B.E. has received support for education from Pylant Medical and compensation for services other than consulting from Smith & Nephew. C.V. has received hospitality payments from Smith & Nephew and support for education from Arthrex. D.W.G. has received royalties from Arthrex and compensation for services other than consulting from Arthrex and Synthes GmbH. K.G.S. has received support for education from Evolution Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Publisher Copyright:
© 2022 The Author(s).

Keywords

MPFL reconstruction
cadaveric specimen
knee anatomy
medial patellofemoral ligament (MPFL)
medial quadriceps tendon–femoral ligament (MQTFL)
patella
pediatric sports medicine
skeletally immature
Patella/anatomy & histology
Humans
Child, Preschool
Infant
Patellar Ligament/anatomy & histology
Tendons/anatomy & histology
Patellofemoral Joint/anatomy & histology
Ligaments, Articular/surgery
Child
Cadaver
Knee Joint/anatomy & histology

PubMed: MeSH publication types

Journal Article

Publisher link

10.1177/03635465221103250

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Baskar, D., Stavinoha, T. J., Sanchez, M., Gupta, A., Randhawa, S. D., Rohde, M. S., Vuong, B., Tompkins, M. A., Ganley, T. J., Ellis, H. B., Wilson, P. L., Fabricant, P. D., VandenBerg, C., Green, D. W., Segovia, N. A., & Shea, K. G. (2022). Quantifying the Relationship Between the Medial Quadriceps Tendon–Femoral Ligament and Patellar Borders: A Pediatric Cadaveric Study. American Journal of Sports Medicine, 50(9), 2433-2438. https://doi.org/10.1177/03635465221103250

Baskar, D, Stavinoha, TJ, Sanchez, M, Gupta, A, Randhawa, SD, Rohde, MS, Vuong, B, Tompkins, MA, Ganley, TJ, Ellis, HB, Wilson, PL, Fabricant, PD, VandenBerg, C, Green, DW, Segovia, NA & Shea, KG 2022, 'Quantifying the Relationship Between the Medial Quadriceps Tendon–Femoral Ligament and Patellar Borders: A Pediatric Cadaveric Study', American Journal of Sports Medicine, vol. 50, no. 9, pp. 2433-2438. https://doi.org/10.1177/03635465221103250

@article{66d6be95450549a6860db4b86986c305,

title = "Quantifying the Relationship Between the Medial Quadriceps Tendon–Femoral Ligament and Patellar Borders: A Pediatric Cadaveric Study",

abstract = "BACKGROUND: The medial patellofemoral complex (MPFC) is a structure composed of the medial quadriceps tendon-femoral ligament (MQTFL) superiorly and the medial patellofemoral ligament (MPFL) inferiorly. The pediatric MPFL anatomy has been well described, but the precise anatomy of the MQTFL has only recently been described and studied in skeletally immature patients.PURPOSE: To describe the anatomic relationship between the MQTFL and its insertion on the quadriceps tendon and patella in pediatric specimens.STUDY DESIGN: Descriptive laboratory study.METHODS: A total of 22 pediatric cadaveric knee specimens were dissected to analyze attachment of the MQTFL to the quadriceps tendon and patella. Dissection was facilitated using lateral parapatellar arthrotomy followed by eversion of the extensor mechanism to evaluate MQTFL fibers from its undersurface.RESULTS: The mean specimen age was 7.4 years. Specimens were divided based on age into a younger cohort (1-2 years), middle cohort (4-8 years), and older cohort (9-12 years). The quadriceps tendon attachment (QTA) of the MQTFL proximal to the patella extended a median of 5.0 mm in the younger cohort, 11.4 mm in the middle cohort, and 12.0 mm in the older cohort, with significant differences found between the younger and middle cohorts ( P < .047) and the younger and older cohorts ( P < .001). The QTA as a percentage of patellar articular height averaged 44.4\% across all specimens. The vertical height of the patella measured a median of 14.0 mm, 22.3 mm, and 27.3 mm in the younger, middle, and older cohorts, respectively. CONCLUSION: This study expands on the recently described anatomy of the pediatric MPFC to quantify the anatomic relationship between the MQTFL attachment to the quadriceps tendon and patella in a more clinically relevant cohort of donor specimens.CLINICAL RELEVANCE: As access to pediatric cadaveric tissue is extremely limited, a better understanding of MPFC and MQTFL anatomy will support surgeons in preoperative planning and intraoperative considerations for their approach to MQTFL and MPFL reconstruction. This may facilitate improved anatomic surgical stabilization of the patellofemoral joint in pediatric patients.",

keywords = "MPFL reconstruction, cadaveric specimen, knee anatomy, medial patellofemoral ligament (MPFL), medial quadriceps tendon–femoral ligament (MQTFL), patella, pediatric sports medicine, skeletally immature, Patella/anatomy \& histology, Humans, Child, Preschool, Infant, Patellar Ligament/anatomy \& histology, Tendons/anatomy \& histology, Patellofemoral Joint/anatomy \& histology, Ligaments, Articular/surgery, Child, Cadaver, Knee Joint/anatomy \& histology",

author = "Danika Baskar and Stavinoha, \{Tyler J.\} and Mark Sanchez and Anshal Gupta and Randhawa, \{Sahej D.\} and Rohde, \{Matthew S.\} and Brian Vuong and Tompkins, \{Marc A.\} and Ganley, \{Theodore J.\} and Ellis, \{Henry B.\} and Wilson, \{Philip L.\} and Fabricant, \{Peter D.\} and Curtis VandenBerg and Green, \{Daniel W.\} and Segovia, \{Nicole A.\} and Shea, \{Kevin G.\}",

note = "Funding Information: One or more of the authors has declared the following potential conflict of interest or source of funding: AlloSource donated the cadaveric specimens and nonfinancial research support for this study. T.J.S. has received hospitality payments from Arthrex and support for education from MedInc of Texas and Midsouth Orthopedics. M.A.T. has received hospitality payments from Aesculap Biologics and a grant from DJO. T.J.G. has received support for education from Liberty Surgical and is an associate editor of AJSM. H.B.E. has received support for education from Pylant Medical and compensation for services other than consulting from Smith \& Nephew. C.V. has received hospitality payments from Smith \& Nephew and support for education from Arthrex. D.W.G. has received royalties from Arthrex and compensation for services other than consulting from Arthrex and Synthes GmbH. K.G.S. has received support for education from Evolution Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Publisher Copyright: {\textcopyright} 2022 The Author(s).",

year = "2022",

month = jul,

doi = "10.1177/03635465221103250",

language = "English (US)",

volume = "50",

pages = "2433--2438",

journal = "American Journal of Sports Medicine",

issn = "0363-5465",

publisher = "SAGE Publications Inc.",

number = "9",

}

TY - JOUR

T1 - Quantifying the Relationship Between the Medial Quadriceps Tendon–Femoral Ligament and Patellar Borders

T2 - A Pediatric Cadaveric Study

AU - Baskar, Danika

AU - Stavinoha, Tyler J.

AU - Sanchez, Mark

AU - Gupta, Anshal

AU - Randhawa, Sahej D.

AU - Rohde, Matthew S.

AU - Vuong, Brian

AU - Tompkins, Marc A.

AU - Ganley, Theodore J.

AU - Ellis, Henry B.

AU - Wilson, Philip L.

AU - Fabricant, Peter D.

AU - VandenBerg, Curtis

AU - Green, Daniel W.

AU - Segovia, Nicole A.

AU - Shea, Kevin G.

N1 - Funding Information: One or more of the authors has declared the following potential conflict of interest or source of funding: AlloSource donated the cadaveric specimens and nonfinancial research support for this study. T.J.S. has received hospitality payments from Arthrex and support for education from MedInc of Texas and Midsouth Orthopedics. M.A.T. has received hospitality payments from Aesculap Biologics and a grant from DJO. T.J.G. has received support for education from Liberty Surgical and is an associate editor of AJSM. H.B.E. has received support for education from Pylant Medical and compensation for services other than consulting from Smith & Nephew. C.V. has received hospitality payments from Smith & Nephew and support for education from Arthrex. D.W.G. has received royalties from Arthrex and compensation for services other than consulting from Arthrex and Synthes GmbH. K.G.S. has received support for education from Evolution Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Publisher Copyright: © 2022 The Author(s).

PY - 2022/7

Y1 - 2022/7

N2 - BACKGROUND: The medial patellofemoral complex (MPFC) is a structure composed of the medial quadriceps tendon-femoral ligament (MQTFL) superiorly and the medial patellofemoral ligament (MPFL) inferiorly. The pediatric MPFL anatomy has been well described, but the precise anatomy of the MQTFL has only recently been described and studied in skeletally immature patients.PURPOSE: To describe the anatomic relationship between the MQTFL and its insertion on the quadriceps tendon and patella in pediatric specimens.STUDY DESIGN: Descriptive laboratory study.METHODS: A total of 22 pediatric cadaveric knee specimens were dissected to analyze attachment of the MQTFL to the quadriceps tendon and patella. Dissection was facilitated using lateral parapatellar arthrotomy followed by eversion of the extensor mechanism to evaluate MQTFL fibers from its undersurface.RESULTS: The mean specimen age was 7.4 years. Specimens were divided based on age into a younger cohort (1-2 years), middle cohort (4-8 years), and older cohort (9-12 years). The quadriceps tendon attachment (QTA) of the MQTFL proximal to the patella extended a median of 5.0 mm in the younger cohort, 11.4 mm in the middle cohort, and 12.0 mm in the older cohort, with significant differences found between the younger and middle cohorts ( P < .047) and the younger and older cohorts ( P < .001). The QTA as a percentage of patellar articular height averaged 44.4% across all specimens. The vertical height of the patella measured a median of 14.0 mm, 22.3 mm, and 27.3 mm in the younger, middle, and older cohorts, respectively. CONCLUSION: This study expands on the recently described anatomy of the pediatric MPFC to quantify the anatomic relationship between the MQTFL attachment to the quadriceps tendon and patella in a more clinically relevant cohort of donor specimens.CLINICAL RELEVANCE: As access to pediatric cadaveric tissue is extremely limited, a better understanding of MPFC and MQTFL anatomy will support surgeons in preoperative planning and intraoperative considerations for their approach to MQTFL and MPFL reconstruction. This may facilitate improved anatomic surgical stabilization of the patellofemoral joint in pediatric patients.

AB - BACKGROUND: The medial patellofemoral complex (MPFC) is a structure composed of the medial quadriceps tendon-femoral ligament (MQTFL) superiorly and the medial patellofemoral ligament (MPFL) inferiorly. The pediatric MPFL anatomy has been well described, but the precise anatomy of the MQTFL has only recently been described and studied in skeletally immature patients.PURPOSE: To describe the anatomic relationship between the MQTFL and its insertion on the quadriceps tendon and patella in pediatric specimens.STUDY DESIGN: Descriptive laboratory study.METHODS: A total of 22 pediatric cadaveric knee specimens were dissected to analyze attachment of the MQTFL to the quadriceps tendon and patella. Dissection was facilitated using lateral parapatellar arthrotomy followed by eversion of the extensor mechanism to evaluate MQTFL fibers from its undersurface.RESULTS: The mean specimen age was 7.4 years. Specimens were divided based on age into a younger cohort (1-2 years), middle cohort (4-8 years), and older cohort (9-12 years). The quadriceps tendon attachment (QTA) of the MQTFL proximal to the patella extended a median of 5.0 mm in the younger cohort, 11.4 mm in the middle cohort, and 12.0 mm in the older cohort, with significant differences found between the younger and middle cohorts ( P < .047) and the younger and older cohorts ( P < .001). The QTA as a percentage of patellar articular height averaged 44.4% across all specimens. The vertical height of the patella measured a median of 14.0 mm, 22.3 mm, and 27.3 mm in the younger, middle, and older cohorts, respectively. CONCLUSION: This study expands on the recently described anatomy of the pediatric MPFC to quantify the anatomic relationship between the MQTFL attachment to the quadriceps tendon and patella in a more clinically relevant cohort of donor specimens.CLINICAL RELEVANCE: As access to pediatric cadaveric tissue is extremely limited, a better understanding of MPFC and MQTFL anatomy will support surgeons in preoperative planning and intraoperative considerations for their approach to MQTFL and MPFL reconstruction. This may facilitate improved anatomic surgical stabilization of the patellofemoral joint in pediatric patients.

KW - MPFL reconstruction

KW - cadaveric specimen

KW - knee anatomy

KW - medial patellofemoral ligament (MPFL)

KW - medial quadriceps tendon–femoral ligament (MQTFL)

KW - patella

KW - pediatric sports medicine

KW - skeletally immature

KW - Patella/anatomy & histology

KW - Humans

KW - Child, Preschool

KW - Infant

KW - Patellar Ligament/anatomy & histology

KW - Tendons/anatomy & histology

KW - Patellofemoral Joint/anatomy & histology

KW - Ligaments, Articular/surgery

KW - Child

KW - Cadaver

KW - Knee Joint/anatomy & histology

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UR - https://www.scopus.com/pages/publications/85133316546#tab=citedBy

U2 - 10.1177/03635465221103250

DO - 10.1177/03635465221103250

M3 - Article

C2 - 35763589

AN - SCOPUS:85133316546

SN - 0363-5465

VL - 50

SP - 2433

EP - 2438

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

IS - 9

ER -

Quantifying the Relationship Between the Medial Quadriceps Tendon–Femoral Ligament and Patellar Borders: A Pediatric Cadaveric Study

Abstract

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