1Department of Orthopedics, Lanzhou University Second Hospital, Gansu Provincial Orthopaedic Clinical Medical Research Center, Gansu Provincial Intelligent Orthopedics Industry Technology Center, Lanzhou 730030, China; 2Lanzhou University Second School of Clinical Medicine, Lanzhou 730030, China
Abstract：Objective This study aimed to summarize the advances in anatomy, biomechanics, reconstruction technique, and clinical outcome of medial patellotibial ligament (MPTL). Methods A computer-based online search in the databases of CNKI, PubMed, and Web of Science was performed to identify articles on the anatomy, biomechanics, and reconstruction of medial patellotibial ligament, and the articles were published before May 2022. A total of 47 articles were retrieved, through screening the references of the above articles, and 21 articles were supplemented. Based on the inclusion and exclusion criteria of this study, a total of 47 articles were finally included (5 articles in Chinese and 42 articles in English) for analysis and summary. Results MPTL was located in the second layer of the medial retinaculum of the knee joint starting from the medial lower end of the patella. It runs along the inner lower part and ends at the anteromedial proximal end of the tibia. The medial binding force of MPTL is about 5%, and it mainly plays a role in the tilt and rotation of knee flexion of 30°-90°. In addition, primary patellar dislocation is often accompanied by combined injury of the medial patellofemoral ligament (MPFL) and MPTL. At present, the reconstruction methods involved in treating MPTL are mainly divided into MPTL reconstruction alone and MPFL combined with MPTL reconstruction. The former has a good clinical outcome, however, the MPTL reconstruction alone does not restore the original biomechanical structure of the medial retinaculum, hence, it is not recommended for clinical application. In several clinical studies of MPFL combined with MPTL reconstruction, the postoperative functional scores (Lysholm, Kujala, and International Knee Documentation Committee [IKDC]), and imaging indicators (patella height, tibial tuberosity-trochlear groove, patella lateral displacement, etc.) have been effectively improved. However, there is no consensus on the surgical indications of MPFL combined with MPTL reconstruction. Conclusions The current study on the anatomy and biomechanics of MPTL has further confirmed the importance of MPTL in maintaining the stability of the patellofemoral joint. Therefore, MPFL combined with MPTL reconstruction can restore the anatomy and biomechanics of the original medial retinaculum. However, it is necessary to further study and demonstrate the indications of this operation to meet the clinical needs.
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2022, Vol. 27 
