Anatomy of the Patellofemoral and Patellotibial Ligaments: A Cadaveric Study Several structures have been identified as having a role in the biomechanics and pathophysiology of the patellofemoral joint. Dynamic components are the quadriceps, pes anserinus and iliotibial band (ITB) complex. Static components are the medial (M) and lateral (L) patellofemoral (PF), patellotibial (PT) and patellomeniscal (PM) complexes. There is a lack of knowledge regarding the anatomy and biomechanical role of the static restrainers. There is a lack of consistency and accuracy regarding the description of these structures in the English literature. Review of the literature is most inconsistent with the description of the patellotibial and patellomeniscal ligaments, terms freely exchanged in some of the previous studies. The goal of this study is threefold. First, to review past literature and find areas of agreement. Second, to identify the static ligament complex of the patellofemoral joint, and third, to clarify the terminology used in previous studies with the hope of gaining some consistency in future studies. Twenty preserved specimens, as well as ten fresh frozen cadavers were dissected. All dissections were performed following the conceptual three plane approach as described by Dr. Marshall. The results of the dissections may be summarized as follows: One, the medial side we identified is a superficial layer which presents some thickening of the fibers oriented from the patella to the tibia and femur. The MPF attachment was felt to be soft tissues and not to bony structures. The MPT ligament has a superficial and deep layer, the superficial layer has a course mimicking the distal ITB complex on the lateral side. A deeper layer was also identified which contained the MPF and MPT ligaments, both of them with firm attachments to bone. A deep capsule layer was found without any obvious thickened fibers. On the lateral side, layer I and II intimately blended into one layer proximally, with two layers being identified distal/anteriorly. A deeper capsular layer was identified which contained consistent thickenings of the fibers in a similar distribution to the LPF and LPT ligaments already described. Again, a two layer PT ligament was found laterally. The patellomeniscal ligaments were seen anteriorly with an inverted "V" configuration between the patellar tendon and the capsule, interspersed within the patella fat pad.Their presence was consistent although their firmness was specimen dependent. Conclusion: The medial and lateral patellofemoral and patellotibial ligament complex, as well as the patellomeniscal ligaments, are always present. However, their size and thickness is specimen dependent. The PT and PM ligaments are different structures, and are regularly identified. There needs to be more consistency in the literature regarding these anatomic structures.

 

 

 

 

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