Radiographic Landmarks for the Anterior Attachment of the Medial Patellofemoral Complex

Purpose: Because fluoroscopy is often used in graft placement during patellar stabilization surgery, the purpose of this study was to describe the radiographic landmarks for the anterior attachment midpoint of the medial patellofemoral complex (MPFC). Methods: Seventeen fresh-frozen cadaveric knees were dissected, and the MPFC was exposed from the articular side after a lateral parapatellar approach. The midpoint of the anterior attachment of the MPFC was identified using a ruler and marked with a pin. Lateral fluoroscopic images of the patella were then obtained and analyzed using digital analysis software. The distance from the superior articular pole to the pin was divided by the length of the articular surface to describe the location of the pin as a percentage of patellar articular length. Results: Of the 17 cadaveric knees, 2 were excluded because of lack of MPFC fibers. In the remaining 15 knees, the mean (±standard deviation) proximal-distal width of the attachment to the patella and/or vastus intermedius tendon was 41 ± 10 mm, spanning from 15 ± 6 mm proximal to the superior pole of the patella to 27 ± 8 mm distal to it. When viewed on lateral fluoroscopic images, the MPFC midpoint was 19% ± 14% of the patellar articular length from the superior articular pole. Conclusions: In this study, the radiographic landmarks that correlate to the anatomic midpoint of the anterior MPFC attachment are 19% ± 14% of the articular surface from the superior pole of the patella. Clinical Relevance: Recent reports on medial patellofemoral ligament anatomy now include fibers that extend to the quadriceps tendon, summarized as the MPFC. With the inclusion of these fibers, the midpoint of the anterior MPFC attachment is more proximal than that of the medial patellofemoral ligament alone. Because fluoroscopy is often used intraoperatively to guide graft placement, this study correlates radiographic landmarks with anatomic findings of the MPFC midpoint on its attachment to the extensor mechanism.