Application of a true lateral virtual radiograph from 3D-CT to identify the femoral reference point of the medial patellofemoral ligament

Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3809-3817. doi: 10.1007/s00167-020-06403-9. Epub 2021 Jan 18.


Purpose: The purpose of this study is two-fold: (1) to describe the femoral reference point of the medial patellofemoral ligament (MPFL) on a virtual true lateral radiograph reconstructed from a three-dimensional computed tomography (3D-CT) image and (2) to compare this point with that of patients without patellofemoral instability and with Schöttle's point.

Methods: A total of 26 consecutive patients (29 affected knees) with recurrent patellar dislocation (RPD), who underwent MPFL reconstruction were included in this study (4 males; 22 females; mean age, 24.0 years old). Using a true lateral 3DCT image, the MPFL femoral insertion was identified and marked with a 2-mm circle, and this image was reconstructed as a virtual true lateral radiograph. Following Schöttle's method, the point of intersection was described by their anterior-posterior and proximal-distal positions. As a control population, 29 age- and gender-matched patients with anterior cruciate ligament (ACL) injuries were also analysed.

Results: The points in RPD patients were located significantly posterior (-2.5 ± 2.3 mm, p < 0.01) to the line representing an extension of the posterior cortex of the femur and distal (- 6.9 ± 2.4 mm, p < 0.01) to the posterior origin of the medial femoral condyle compared with those in the control population. The mean reference point of RPD patients was located in a 3.8-mm posterior and 4.4-mm distal position compared with Schöttle's point.

Conclusions: An anatomical and radiographic femoral reference point of the MPFL on a true lateral virtual radiograph was described with our method. In patients with RPD, this reference point was identified to be more posterior and distal to Schöttle's point. More anatomical and individualized MPFL reconstruction will be secured using our method.

Level of evidence: Level IV.

Keywords: Femoral reference point; Medial patellofemoral ligament; Three-dimensional computed tomography; Virtual radiograph.

MeSH terms

  • Adult
  • Female
  • Femur / diagnostic imaging
  • Humans
  • Knee Joint
  • Ligaments, Articular / diagnostic imaging
  • Male
  • Patellar Dislocation* / diagnostic imaging
  • Patellofemoral Joint* / diagnostic imaging
  • Tomography, X-Ray Computed
  • Young Adult