Suitability of Ultrasound as Noninvasive Approach to Define the Femoral Attachment Area of the Medial Patellofemoral Ligament: A Feasibility Study

Abstract Background: Anatomical characteristics and landmarks are of overarching importance for many surgical procedures. The anatomical characteristics of the medial femoral condyle are of great clinical relevance, since they include the origin and attachment surfaces of many knee joint stabilizing structures. The surgical repair technique of the medial patellofemoral ligament (MPFL) with X-ray assistance has been described as a difficult method due to uncertain femoral placement. This study aimed to determine the diagnostic value and applicability of ultrasound for the femoral origin and landmark definition of the MPFL. Methods: To evaluate anatomical landmarks of the MPFL attachment area, a linear ultrasound probe with musculoskeletal pre-set was used to determine the identifiability, size, and special relationship of the adductor tubercle and the medial femoral epicondyle (ME). Measurements were carried out in 30 knee joints of healthy adult participants ( n participants = 15). Intra- and interobserver reliability were assessed within three different measurement time points and between two investigators . Results: The ME could be visualized in 94.5% and the tuberculum adductorium in 99.4% of all cases. Intrarater reliability was assessed with an intraclass correlation coefficient (ICC) score of 0.96. Interrater reliability demonstrated an ICC score of 0.94 for the measured mean values. Conclusion: Ultrasound seems to be an applicable and useful noninvasive tool to reliably identify the MPFL attachment area using the adductor tubercle and the ME as bony landmarks. Our findings emphasize the potential role of ultrasound in the assessment of bony anatomical landmarks, offering implications for MPFL reconstruction techniques.