When Talking About Mpfl, What Landmark Does Schöttle Point Allude To?

The Schöttle point locating method, established in 2007, is a radiographic landmark used for anatomic femoral attachment points during medial patellofemoral ligament (MPFL) reconstruction. It is widely used in clinical practice and can be identified on lateral fluoroscopic radiographs 2-mm anterior to the posterior cortex of the femur and 2-mm distal to the femur. The Schöttle point provides a safe and reliable radiographic landmark for pediatric MPFLR, although reaming diameter should be considered.

The Schöttle point is commonly used for anatomic femoral tunnel placement during MPFL reconstruction. The origin on the medial femur is referred to as Schottle’s point, named after the surgeon who best described the anatomy. The isometric point of graft fixation is precisely determined by Schottle, which should be located between the medial femoral epicondyle and the MPFL footprint area relative to the average peak points of the osseous landmarks.

The ideal position is assessed with Schöttle’s point (yellow spot), which is the extension of the posterior cortical line and the line between the posterior cortical line and the femoral epicondyle. The study aimed to analyze the anatomic landmarks of Schöttle’s point and establish a locating method for identification. The Schöttle point is the most frequently employed reference standard for femoral tunnel position in MPFL reconstruction.

What landmark does Schottles Point refer to when discussing MPFL?

The graft should be placed anatomically at Schottle’s point on the medial femur to prevent overstretching and joint failure. The patellar insertion should cover the proximal and middle thirds of the medial patella. Suture anchors and femoral socket are prepared. The graft tension should be appropriate to control lateral excursion and allow side-to-side patella translation. The tendon is sutured into the medial patella attachment with suture anchors and fixed in the medial femoral socket with an interference screw.

Where is the MPFL located in the body?

The medial patellofemoral ligament (MPFL) is a crucial network of soft tissue restraints that stabilizes the knee, ensuring proper leg movement. It is located on the inner side of the knee and connects the patella to the femur. MPFL injuries, particularly in females and athletes, can result from forceful, traumatic patella dislocations. Dr. Riley J. Williams, an orthopedic knee specialist, has extensive experience in treating MPFL injuries, MPFL tears, and MPFL insufficiency.

An MPFL tear occurs when the patella moves laterally relative to the femur, causing acute pain and swelling. The MPFL acts as a natural restraint against abnormal lateral movement. During a dislocation, the kneecap may lock in place, and recovery may involve a brace, rest, and physical therapy.

MPFL insufficiency is a chronic state where the medial patellofemoral ligament fails to function properly due to an injury, such as a knee dislocation or sustained trauma. This can lead to repeated patellar dislocations, pain, stiffness, and limited range of motion. In order to treat MPFL injuries, it is essential to consult with a specialist like Dr. Williams.

How do you test for MPFL tear?

Radiographic images can indicate a possible MPFL tear, with lateral subluxation of the patella indicating bony contusions. Magnetic Resonance Imaging (MRI) provides the most accurate assessment of MPFL soft tissue integrity. When referencing academic writing, it is important to reference the primary source, such as the journal article where the information was first stated. Physiopedia articles are best used to find the original sources of information.

The Medial Patellofemoral Ligament (MPFL) is an hour-glass-shaped ligament made of retinacular tissue, playing a crucial role in stabilizing the medial aspect of the patella, especially during early knee flexion. It is a critical component in patellar tracking and stability within the trochlear groove.

What is the MPFL surface anatomy?

The Medial Patellafemoral Ligament (MPFL) is an hourglass-shaped structure that runs from a triangular space between the adductor tubercle, medial femoral epicondyle, and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. It is crucial for immediate surgical repair of medial patellar stabilizers for acute patellar dislocation. Anatomical studies have shown that the MPFL has an extensor mechanism, which is essential for proper functioning of the knee joint. Immediate surgical repair of the MPFL is recommended for acute patellar dislocation.

What are the landmarks of the knee joint line?

In revision total knee arthroplasty (TKA), surgeons can use various methods to determine the correct joint line level. The primary implant can be used as a guide for joint line level before being removed, but this method requires an accurate implant level. Contralateral knee radiographs can also be used as a template and guide for joint level if available and without anatomical distortion. Intraoperative landmarks, divided into soft tissue and bony landmarks, are the most widely used method to guide the accurate joint line level.

The medial epicondyle, lateral epicondyle, tibial tubercle, fibular head, and inferior pole of the patella are commonly used landmarks in clinical settings. Studies have found that distances from these landmarks to the knee joint line are 33. 9, 33. 4, and 12. 2 mm, respectively. Jawhar et al. reported that the distance from fibular head to the knee joint line was 10 mm. Mason et al. suggested that the knee joint line level can be found at the level of inferior pole patellar or 2 cm above the fibular head on an extended knee.

The current study chose to evaluate the most prominent point of medial epicondyle rather than the medial epicondyle sulcus due to its accuracy and ease of location in a surgical setting. However, distances C and E between this study and other studies were comparable, possibly due to high variability in both landmarks. Previous studies have reported that the fibular head and lower pole patellar are not reliable landmarks to locate the knee joint line due to their position variability.

To overcome the weakness of distances from landmarks to the joint line, Servien et al. suggested converting these measured distances into a ratio of the femoral transepicondylar width (epicondylar ratio). The current study compared epicondylar ratios with other studies and found that the standard deviation and range of C/FW, D/FW, and E/FW were still wider than other parameters.

Many studies supported the results that C/FW and E/FW had high standard variation, independent of patient size, and concluded that fibular head and inferior pole patellar are not reliable landmarks to guide joint line level in revision TKA. The ratio of D/FW in many studies seems to be reliable for use as the tibial side landmark, but our results demonstrated that D/FW had a high standard deviation, wide range, and a significant difference between males and females. The differences between our outcomes and previous research may be explained by variations in participant ethnicity, participant selection, measurement methodology, or observer differences.

How to find Schottle’s point?

The Schöttle-Schöttle point is an anatomic isometric insertion of the medial patellofemoral ligament, determined on the lateral view by a line extending from the posterior cortex and another perpendicular to the first, just proximal to the posterior most point of the Blumensaat line. It is 1 mm anterior to the intersection of these two lines. Recurrent patellar instability is a challenging problem for surgeons, with most complications being secondary to technical errors.

To ensure accurate placement of the femoral tunnel, a radiographic technique is used with a guide pin. Servien et al. described a tunnel placement tangent to the posterior condyle and to a perpendicular line at the posterior-most aspect of the Blumensaat line with a zone of 7 mm. Steensen et al. found femoral tunnel placement to be crucial for establishing isometry of the medial patellofemoral ligament, with the femoral tunnel located at an anatomic point 6. 2-6 1. 5 mm distal to the adduct tubercle and 13. 3-6 2. 4 mm proximal to the medial femoral epicondyle.

How do you palpate MPFL?

The clinician employs a passive gliding motion of the patella in the lateral direction, estimating the degree of translation by dividing the movement into longitudinal quadrants.

What is the landmark of the patella?

The patella is a triangular bone located at the front of the knee joint, within the patellofemoral groove of the femur. Its superior aspect is attached to the quadriceps tendon, while its inferior aspect is connected to the patellar ligament. The patella is classified as a sesamoid type bone due to its position within the quadriceps tendon and is the largest sesamoid bone in the body. Its anatomy, surface features, functions, and clinical relevance are discussed in this article.

What is the Schottles point of the femur?

Schottle’s point is a radiographic landmark that indicates the isometric point of femoral insertion during medial patellofemoral ligament (MPFL) reconstruction. It can be identified intraoperatively using fluoroscopy. A technique is described to identify this point without using fluoroscopy and radiation exposure to the patient or surgeon. The technique involves making a 2-3 cm longitudinal incision medially, centered over the medial epicondyle (ME).

After superficial and deep dissection, the adductor tubercle (AT) and posterior cortex of the femur are felt. The ME is anterior and distal to the AT, and the guidewire entry point is approximately 5mm anterior and distal to the AT, between the AT and ME. These landmarks are felt with the guidewire before it is drilled through at the correct site.

What is the insertion point for the patellar ligament?

The patellar ligament is connected to the distal pole of the patella and inserts onto the tibial tuberosity. ScienceDirect employs the use of cookies and gathers data pertaining to the functionality and usage of the website. Copyright © 2024 Elsevier B. V., its licensors, and contributors. All rights are reserved, including those pertaining to text and data mining, AI training, and analogous technologies. The open access content is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4. 0 International License.

What anatomical landmark does the patella ride in on the femur?

The patella, the largest sesamoid bone in the body, is situated at the anterior aspect of the knee joint, within the patellofemoral groove of the femur. The superior aspect is attached to the quadriceps tendon, while the inferior aspect is attached to the patellar ligament. This article examines the anatomy, surface features, functions, and clinical relevance of the patella.