Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy.

PURPOSE: The medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the medial patella. The exact position reported in the literature varies. Understanding the true anatomical origin and insertion of the MPFL is critical to successful reconstruction. The purpose of this systematic review was to determine these locations. METHODS: A systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016. All papers investigating the anatomy of the MPFL were eligible. Methodological quality was assessed using a modified CASP tool. A narrative analysis approach was adopted to synthesise the findings. RESULTS: After screening and review of 2045 papers, a total of 67 studies investigating the relevant anatomy were included. From this, the origin appears to be from an area rather than (as previously reported) a single point on the medial femoral condyle. The weighted average length was 56 mm with an 'hourglass' shape, fanning out at both ligament ends. CONCLUSION: The MPFL is an hourglass-shaped structure running from a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. Awareness of anatomy is critical for assessment, anatomical repair and successful surgical patellar stabilisation. LEVEL OF EVIDENCE: Systematic review of anatomical dissections and imaging studies, Level IV.

Fracture of Bilok interference screws on insertion during anterior cruciate ligament reconstruction.

New femoral and tibial interference screws for use during anterior cruciate ligament (ACL) reconstruction have been developed using a composite of poly-L-lactic acid (PLLA) and tricalcium phosphate (TCP). The combination is described as having better incorporation than standard bioabsorbable screws with no loss of mass during incorporation and without the brittle nature associated with conventional TCP implants. However, the screw can fracture during insertion, leaving the distal third inside the femoral or tibial tunnel, making extraction and revision difficult. This is a report of 2 cases of PLLA-TCP screw breakage, 1 occurring in the femoral tunnel and 1 occurring in the tibial tunnel.

An improved technique for arthroscopic resection of the acromioclavicular joint.

Resection is the accepted treatment for arthritis of the acromioclavicular joint. It may be performed either open or arthroscopically. During arthroscopic resection, visualizing the superior aspect of the joint and determining the limit of resection can be difficult. We describe a new technique to improve visualization during the procedure.

Arthroscopic management of calcific tendinitis of the popliteus tendon.

Calcific tendinitis is seen most commonly affecting the rotator cuff but has not been previously reported affecting the popliteus tendon. Symptoms mimic a tear of the posterior horn of the lateral meniscus. Arthroscopic debridement of the calcific deposit results in resolution of symptoms.

A review of the special tests associated with shoulder examination. Part II: laxity, instability, and superior labral anterior and posterior (SLAP) lesions.

This is the second of a two-part article describing the various tests that have been used to examine the shoulder to find and treat problems in that area. Part I of this article (January/February 2003, pages 154-160) focused on tests used to examine rotator cuff abnormalities. This article attempts to clarify the tests of laxity, instability, and the superior labral anterior and posterior (SLAP) lesions by presenting them as described by the original authors, with the additional aim of providing a source for those wishing to refresh their knowledge without the need to refer to the original source material.

A review of the special tests associated with shoulder examination. Part I: the rotator cuff tests.

Careful examination of the shoulder is an essential component in forming a diagnosis of problems in this area. A number of tests have been described that are claimed to improve diagnostic accuracy by specifically examining one component of the shoulder complex. Many of these tests are eponymous, and there is confusion about not only how to perform them but also what conclusion to draw from the results. This article attempts to clarify the tests used to examine the rotator cuff by presenting them as described by the original authors with the additional aim of providing a source for those wishing to refresh their knowledge without the need to refer to the original source material.