0:01

Let's talk about patellar stabilization and

0:05

the medial patellofemoral ligament,

0:08

the main stabilizer of the patella

0:10

that keeps it from dislocating.

0:13

It originates along the upper aspect of the patella,

0:18

courses posteriorly,

0:20

and it inserts in a space between the adductor tubercle and the

0:25

medial femoral epicondyle, which I'll show you in a moment.

0:28

But you can see there's a little protrusion or bump right here.

0:31

Directly in back of it is the origin of

0:34

the medial gastrocnemius tendon.

0:37

And directly beneath it is the superficial portion of the medial

0:41

collateral ligament known as the crus or superficial MCL

0:45

or SMCL, which becomes or blends with more posteriorly,

0:50

these oblique triangular fibers with

0:52

apex pointed directly posteriorly,

0:55

known as the posterior oblique ligament of the knee.

0:58

So this is part of the superficial layer of the MCL.

1:01

It comes directly up underneath and blends

1:04

with the medial patellofemoral ligament.

1:06

And right underneath here is going to be the tibial

1:10

collateral ligament. So very intimate anatomy.

1:13

Now, if that were not enough,

1:15

there are additional stabilizers of the patella,

1:18

but only one is meaningful,

1:20

and that is this one that comes off the meniscus known

1:23

as the medial patellomeniscal ligament or MPML,

1:29

and that inserts on the inferior aspect of the patella.

1:32

It can be very difficult to see on MRI.

1:34

And then there's a thin little wispy one

1:37

called the MPTL coming off the tibia.

1:41

So I'll make it kind of dotted, and it comes along

1:44

onto the inferior aspect of the patella.

1:47

So like the wizard of Oz,

1:49

pay no attention to that one since

1:50

it has no role, in other words,

1:52

pay no attention to the man behind the curtain because

1:54

it has really no role in patellar stabilization.

1:58

So let's take a picture of all the attachments and tubercles

2:01

and bumps, and draw in the MPFL on our own.

2:05

The MPFL comes off the upper aspect of the patella.

2:09

It courses posteriorly.

2:11

And we said it lands in a depression between the tubercle of the

2:18

femur, right here. And the tubercle of the adductor

2:22

magnus or adductor magnus tubercle, AMT.

2:25

So right there.

2:26

We also said that coming down from it are

2:30

superficial portions of the MCL known as the

2:34

superficial MCL or SMCL or cruis layer.

2:37

So that comes down more vertically.

2:39

And then a little bit more triangular

2:42

would be the POL or posterior oblique ligament.

2:45

And these kind of blend together and they

2:47

all kind of mesh together as one.

2:49

And underneath this would be the tibial collateral ligament.

2:53

We also said that there is a meniscopatellar ligament.

2:58

We'll make that another color.

3:00

And we'll make that one blue.

3:01

So the meniscus would be right here.

3:03

It comes to the inferior third of the patella.

3:06

And then we're not going to draw the patellotibial ligament

3:11

because it really doesn't have much of a role,

3:12

or maybe we'll just give it a few little dots

3:14

just to let you know that it's there.

3:16

So these are the two main stabilizers of the patella.

3:21

Now, if you flip over to the next vignette that talks about

3:25

the MPFL on MRI, I'm going to demonstrate it on MRI.

3:29

So these are kind of paired vignettes.