A proposed method for locating the tibial attachment for medial patellotibial ligament reconstruction: A cadaveric anatomical and imaging study
Xinyu Tang, Dongfang Zhang, Haitao Fu, Di Qu, Xinkun Han, Tao Li, Chao QiAbstract
Purpose
To determine the attachment sites of the medial patellofemoral ligament (MPFL) and medial patellotibial ligament (MPTL) through anatomical and imaging measurements, and to suggest a possible method for locating the tibial attachment of MPTL for reconstruction purposes.
Methods
Twenty‐six adult knee specimens (16 formalin‐fixed, 10 fresh‐frozen) underwent anatomical and imaging measurements, including the morphology of MPFL and MPTL and distances from their attachment points to bony landmarks. Two parameters were used to determine the MPTL tibial attachment position: (1) Anatomical vertical distance to the tibial joint line; (2) a/b ratio on anteroposterior (AP) X‐ray. For the a/b ratio, line 1 was defined as perpendicular to the tibial joint line and passing through the tibial tuberosity centre, and line 2 was drawn parallel to line 1 and passing through the medial edge of the femoral medial epicondyle; the vertical distance from the MPTL tibial attachment to line 1 was termed ‘a’, and the distance between line 1 and line 2 was termed ‘b’.
Results
The MPFL and MPTL were consistently identified in second layer of the medial retinaculum. The tibial attachment of MPTL was 14.0 ± 0.7 mm from the tibial joint line, and the a/b ratio on the AP X‐ray was 0.51 ± 0.03. Additional anatomical parameters, including ligament dimensions and distances to surrounding bony landmarks, were also documented. There were no significant differences between the results of the imaging and anatomical measurements of the distances from the ligament attachment points to the bony landmarks ( p > 0.05).
Conclusion
For MPTL reconstruction, the tibial attachment can be located 14 mm distal to the joint line and halfway between the tibial tuberosity centre and medial epicondyle (a/b = 0.51). This method serves as a reference and warrants further validation in biomechanical and reproducibility studies.
Level of Evidence
Level V, cadaveric anatomical study.