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Medial Patellofemoral Ligament: Cadaveric Investigation of Anatomy with MRI, MR Arthrography, and Histologic Correlation

¹ Department of Radiology (114), University of California, San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA.
² Present address: Izmir Ataturk Egitim ve Arastirma Hastanesi, Radyoloji Servisi, Yesilyrt, Izmir, Turkey.
³ Department of Pathology, University of California, San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA.

View larger version (54K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —40-year-old man with history of knee pain. Axial T1-weighted spin-echo (TR/TE, 516/14) (A) and T2-weighted fat-suppressed (4,000/61) (B) images show apparent detachment (thick arrows) of medial patellofemoral ligament (thin arrows) without other evidence of recent patellar dislocation.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —40-year-old man with history of knee pain. Axial T1-weighted spin-echo (TR/TE, 516/14) (A) and T2-weighted fat-suppressed (4,000/61) (B) images show apparent detachment (thick arrows) of medial patellofemoral ligament (thin arrows) without other evidence of recent patellar dislocation.

View larger version (33K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Cadaver of 74-year-old woman. Serial axial T1-weighted spin-echo MR images (TR/TE, 550/20–21) from superior to inferior aspect show attachment site of adductor magnus tendon (arrow, A) immediately above attachment site of medial patellofemoral ligament (black arrows, B and C) and tibial collateral ligament (open arrow, B and C). Arrowheads in A and B indicate synovium without distention of joint.

View larger version (34K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Cadaver of 74-year-old woman. Serial axial T1-weighted spin-echo MR images (TR/TE, 550/20–21) from superior to inferior aspect show attachment site of adductor magnus tendon (arrow, A) immediately above attachment site of medial patellofemoral ligament (black arrows, B and C) and tibial collateral ligament (open arrow, B and C). Arrowheads in A and B indicate synovium without distention of joint.

View larger version (35K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Cadaver of 74-year-old woman. Serial axial T1-weighted spin-echo MR images (TR/TE, 550/20–21) from superior to inferior aspect show attachment site of adductor magnus tendon (arrow, A) immediately above attachment site of medial patellofemoral ligament (black arrows, B and C) and tibial collateral ligament (open arrow, B and C). Arrowheads in A and B indicate synovium without distention of joint.

View larger version (42K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Cadaver of 80-year-old-woman. Serial coronal T1-weighted spin-echo MR images (TR/TE, 550/20–21) from anterior to posterior (A–D) aspect and correlative anatomic photographs (E–H) show medial patellofemoral ligament (solid black arrows) as thin band of low signal intensity attaching in anterior aspect to patella (P) and continuous under tendinous fibers (white arrows) of vastus medialis obliquus (VMO) muscle. Differentiation of femoral attachment point of medial patellofemoral ligament from femoral attachment point of tibial collateral ligament (open black arrows) is not clear.

View larger version (41K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Cadaver of 80-year-old-woman. Serial coronal T1-weighted spin-echo MR images (TR/TE, 550/20–21) from anterior to posterior (A–D) aspect and correlative anatomic photographs (E–H) show medial patellofemoral ligament (solid black arrows) as thin band of low signal intensity attaching in anterior aspect to patella (P) and continuous under tendinous fibers (white arrows) of vastus medialis obliquus (VMO) muscle. Differentiation of femoral attachment point of medial patellofemoral ligament from femoral attachment point of tibial collateral ligament (open black arrows) is not clear.

View larger version (40K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Cadaver of 80-year-old-woman. Serial coronal T1-weighted spin-echo MR images (TR/TE, 550/20–21) from anterior to posterior (A–D) aspect and correlative anatomic photographs (E–H) show medial patellofemoral ligament (solid black arrows) as thin band of low signal intensity attaching in anterior aspect to patella (P) and continuous under tendinous fibers (white arrows) of vastus medialis obliquus (VMO) muscle. Differentiation of femoral attachment point of medial patellofemoral ligament from femoral attachment point of tibial collateral ligament (open black arrows) is not clear.

View larger version (42K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Cadaver of 80-year-old-woman. Serial coronal T1-weighted spin-echo MR images (TR/TE, 550/20–21) from anterior to posterior (A–D) aspect and correlative anatomic photographs (E–H) show medial patellofemoral ligament (solid black arrows) as thin band of low signal intensity attaching in anterior aspect to patella (P) and continuous under tendinous fibers (white arrows) of vastus medialis obliquus (VMO) muscle. Differentiation of femoral attachment point of medial patellofemoral ligament from femoral attachment point of tibial collateral ligament (open black arrows) is not clear.

View larger version (48K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —Cadaver of 80-year-old-woman. Serial coronal T1-weighted spin-echo MR images (TR/TE, 550/20–21) from anterior to posterior (A–D) aspect and correlative anatomic photographs (E–H) show medial patellofemoral ligament (solid black arrows) as thin band of low signal intensity attaching in anterior aspect to patella (P) and continuous under tendinous fibers (white arrows) of vastus medialis obliquus (VMO) muscle. Differentiation of femoral attachment point of medial patellofemoral ligament from femoral attachment point of tibial collateral ligament (open black arrows) is not clear.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —Cadaver of 80-year-old-woman. Serial coronal T1-weighted spin-echo MR images (TR/TE, 550/20–21) from anterior to posterior (A–D) aspect and correlative anatomic photographs (E–H) show medial patellofemoral ligament (solid black arrows) as thin band of low signal intensity attaching in anterior aspect to patella (P) and continuous under tendinous fibers (white arrows) of vastus medialis obliquus (VMO) muscle. Differentiation of femoral attachment point of medial patellofemoral ligament from femoral attachment point of tibial collateral ligament (open black arrows) is not clear.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3G —Cadaver of 80-year-old-woman. Serial coronal T1-weighted spin-echo MR images (TR/TE, 550/20–21) from anterior to posterior (A–D) aspect and correlative anatomic photographs (E–H) show medial patellofemoral ligament (solid black arrows) as thin band of low signal intensity attaching in anterior aspect to patella (P) and continuous under tendinous fibers (white arrows) of vastus medialis obliquus (VMO) muscle. Differentiation of femoral attachment point of medial patellofemoral ligament from femoral attachment point of tibial collateral ligament (open black arrows) is not clear.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3H —Cadaver of 80-year-old-woman. Serial coronal T1-weighted spin-echo MR images (TR/TE, 550/20–21) from anterior to posterior (A–D) aspect and correlative anatomic photographs (E–H) show medial patellofemoral ligament (solid black arrows) as thin band of low signal intensity attaching in anterior aspect to patella (P) and continuous under tendinous fibers (white arrows) of vastus medialis obliquus (VMO) muscle. Differentiation of femoral attachment point of medial patellofemoral ligament from femoral attachment point of tibial collateral ligament (open black arrows) is not clear.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Cadaver of 74-year-old woman. Serial axial T1-weighted spin-echo MR images, (TR/TE, 550/20–21) (A and B) and correlative anatomic photograph (C) show crural fascia (curved arrows, B), outer tendinous fibers of vastus medialis obliquus muscle (VMO) (arrowheads), and superior fibers of medial patellofemoral ligament (straight arrows).

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Cadaver of 74-year-old woman. Serial axial T1-weighted spin-echo MR images, (TR/TE, 550/20–21) (A and B) and correlative anatomic photograph (C) show crural fascia (curved arrows, B), outer tendinous fibers of vastus medialis obliquus muscle (VMO) (arrowheads), and superior fibers of medial patellofemoral ligament (straight arrows).

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Cadaver of 74-year-old woman. Serial axial T1-weighted spin-echo MR images, (TR/TE, 550/20–21) (A and B) and correlative anatomic photograph (C) show crural fascia (curved arrows, B), outer tendinous fibers of vastus medialis obliquus muscle (VMO) (arrowheads), and superior fibers of medial patellofemoral ligament (straight arrows).

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Cadaver of 74-year-old woman. Photomicrograph of histologic section shows fibers of medial patellofemoral ligament (white arrows) intertwined and bridged (curved arrows) with fibers of vastus medialis obliquus muscle (straight open arrows). (H and E, x2)

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4E —Cadaver of 74-year-old woman. Photomicrograph of histologic section shows crural fascia (curved arrows), tendinous fibers of vastus medialis obliquus muscle (arrowheads), and superior fibers of medial patellofemoral ligament (straight arrows). (H and E, x2)

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Cadaver of 88-year-old man. Serial axial T1-weighted spin-echo MR images (TR/TE, 550/20–21) (A–C) and anatomic photograph (D) show parallel course of superior part of medial patellofemoral ligament (white arrow) and inferior fibers of vastus medialis obliquus (VMO) muscle and tendon (black arrows).

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Cadaver of 88-year-old man. Serial axial T1-weighted spin-echo MR images (TR/TE, 550/20–21) (A–C) and anatomic photograph (D) show parallel course of superior part of medial patellofemoral ligament (white arrow) and inferior fibers of vastus medialis obliquus (VMO) muscle and tendon (black arrows).

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Cadaver of 88-year-old man. Serial axial T1-weighted spin-echo MR images (TR/TE, 550/20–21) (A–C) and anatomic photograph (D) show parallel course of superior part of medial patellofemoral ligament (white arrow) and inferior fibers of vastus medialis obliquus (VMO) muscle and tendon (black arrows).

View larger version (198K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —Cadaver of 88-year-old man. Serial axial T1-weighted spin-echo MR images (TR/TE, 550/20–21) (A–C) and anatomic photograph (D) show parallel course of superior part of medial patellofemoral ligament (white arrow) and inferior fibers of vastus medialis obliquus (VMO) muscle and tendon (black arrows).

View larger version (45K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —Diagram shows normal anatomic details of medial patellofemoral ligamentous complex seen on serial axial MR images. VMO = vastus medialis obliquus muscle, QT = quadriceps tendon, PT = patellar tendon. Single straight arrow indicates inferior fibers of VMO; open arrow (B), medial patellofemoral ligament; double arrows (C), crural fascia; open arrow (D), tibial collateral ligament; arrowhead (E), medial patellomeniscal ligament; curved arrow (E), medial patellotibial ligament.

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View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Cadaver of 79-year-old man. Axial T1-weighted spin-echo MR arthrographic image (TR/TE, 550/20–21) (A), anatomic photograph (B), and photomicrograph of histologic section (H and E, x2) (C) show fibers of medial patellofemoral ligament (black arrows) merging with tibial collateral ligament (white straight arrows). Open arrow (C) indicates attachment between medial patellofemoral ligament and tibial collateral ligament. Arrowhead indicates joint capsule; curved arrow (A and B), crural fascia. B = bone.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Cadaver of 79-year-old man. Axial T1-weighted spin-echo MR arthrographic image (TR/TE, 550/20–21) (A), anatomic photograph (B), and photomicrograph of histologic section (H and E, x2) (C) show fibers of medial patellofemoral ligament (black arrows) merging with tibial collateral ligament (white straight arrows). Open arrow (C) indicates attachment between medial patellofemoral ligament and tibial collateral ligament. Arrowhead indicates joint capsule; curved arrow (A and B), crural fascia. B = bone.

View larger version (171K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —Cadaver of 79-year-old man. Axial T1-weighted spin-echo MR arthrographic image (TR/TE, 550/20–21) (A), anatomic photograph (B), and photomicrograph of histologic section (H and E, x2) (C) show fibers of medial patellofemoral ligament (black arrows) merging with tibial collateral ligament (white straight arrows). Open arrow (C) indicates attachment between medial patellofemoral ligament and tibial collateral ligament. Arrowhead indicates joint capsule; curved arrow (A and B), crural fascia. B = bone.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7D —Cadaver of 79-year-old man. Axial T1-weighted spin-echo MR arthrographic image (550/20–21) (D), anatomic photograph (E), and photomicrograph of histologic section (H and E, x4) (F) immediately below A–C show inner fibers of medial patellofemoral ligament (arrowheads, F) merging with tibial collateral ligament (straight arrows) and outer fibers of medial patellofemoral ligament (curved arrows) wrapping over tibial collateral ligament and coursing posteriorly. B = bone.

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7E —Cadaver of 79-year-old man. Axial T1-weighted spin-echo MR arthrographic image (550/20–21) (D), anatomic photograph (E), and photomicrograph of histologic section (H and E, x4) (F) immediately below A–C show inner fibers of medial patellofemoral ligament (arrowheads, F) merging with tibial collateral ligament (straight arrows) and outer fibers of medial patellofemoral ligament (curved arrows) wrapping over tibial collateral ligament and coursing posteriorly. B = bone.

View larger version (186K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7F —Cadaver of 79-year-old man. Axial T1-weighted spin-echo MR arthrographic image (550/20–21) (D), anatomic photograph (E), and photomicrograph of histologic section (H and E, x4) (F) immediately below A–C show inner fibers of medial patellofemoral ligament (arrowheads, F) merging with tibial collateral ligament (straight arrows) and outer fibers of medial patellofemoral ligament (curved arrows) wrapping over tibial collateral ligament and coursing posteriorly. B = bone.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —Cadaver of 93-year-old man. Axial T1-weighted spin-echo MR arthrographic image (TR/TE, 550/20–21) (A), anatomic photograph (B), and photomicrograph of histologic section (H and E, x4) (C) show all fibers of medial patellofemoral ligament (open arrows) merging with tibial collateral ligament (solid arrows). Curved arrow (A and B) indicates crural fascia.

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —Cadaver of 93-year-old man. Axial T1-weighted spin-echo MR arthrographic image (TR/TE, 550/20–21) (A), anatomic photograph (B), and photomicrograph of histologic section (H and E, x4) (C) show all fibers of medial patellofemoral ligament (open arrows) merging with tibial collateral ligament (solid arrows). Curved arrow (A and B) indicates crural fascia.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —Cadaver of 93-year-old man. Axial T1-weighted spin-echo MR arthrographic image (TR/TE, 550/20–21) (A), anatomic photograph (B), and photomicrograph of histologic section (H and E, x4) (C) show all fibers of medial patellofemoral ligament (open arrows) merging with tibial collateral ligament (solid arrows). Curved arrow (A and B) indicates crural fascia.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —Cadaver of 85-year-old man. Serial axial T1-weighted spin-echo MR arthrographic images (TR/TE, 550/20–21) show medial patellomeniscal ligament (curved arrows, A and B), medial patellotibial ligament (open arrows), and tibial collateral ligament (solid arrows, A and B). M = anterior horn of medial meniscus, T = tibia.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —Cadaver of 85-year-old man. Serial axial T1-weighted spin-echo MR arthrographic images (TR/TE, 550/20–21) show medial patellomeniscal ligament (curved arrows, A and B), medial patellotibial ligament (open arrows), and tibial collateral ligament (solid arrows, A and B). M = anterior horn of medial meniscus, T = tibia.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —Cadaver of 85-year-old man. Serial axial T1-weighted spin-echo MR arthrographic images (TR/TE, 550/20–21) show medial patellomeniscal ligament (curved arrows, A and B), medial patellotibial ligament (open arrows), and tibial collateral ligament (solid arrows, A and B). M = anterior horn of medial meniscus, T = tibia.

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