The effect of quadriceps anatomical factors on patellar stability: A systematic review

• Published in: The knee Vol. 41; pp. 29 - 37
• Main Authors: Abelleyra Lastoria, D.A., Benny, C.K., Hing, C.B.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2023
• Subjects: Anatomy; Humans; Knee Joint; Ligaments; Patella; Quadriceps; Quadriceps Muscle; Range of Motion, Articular; Stability; Quadriceps; OpenSIGLE; LPD; AQUA; Stability; QT; MRP; Anatomy; Patella; VMP; VMO; Q-angle; EFORT
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2022.12.015

•Vastus medialis obliquus strength is a determinant of patellar stability.•The lateral retinaculum contributes to patellar stability throughout knee flexion.•The medial retinaculum contributes to patellar stability up to 30˚ knee flexion.•Quadriceps angle affects patellar stability during knee flexion, but not extension. The aim of this systematic review was to analyse the effect of quadriceps anatomical factors on patellar stability. The protocol for this review was registered on PROSPERO with registration number CRD42022334265. A systematic PRISMA compliant database search was conducted. Electronic databases (MEDLINE, Global Health, MIDIRS, Embase, PsycARTICLES and APA PsycInfo), currently registered studies, conference proceedings and the reference lists of included studies were searched. A narrative synthesis provided a summary of current evidence pertaining to the effect of quadriceps anatomical factors on patellar stability. A total of 9168 records were screened in the initial search. Of these, 20 articles satisfied the inclusion criteria, assessing 754 knees of 689 patients, and 69 cadaveric knees. Vastus medialis obliquus strength (VMO) affected patellar stability up to 15° of knee flexion, whereas medial retinaculum integrity did so up to 30° of knee flexion. Studies disagreed as to whether this applied to the rest of knee flexion. There is conflicting evidence regarding the effect of VMO elevation, cross-sectional area and angulation on patellar stability. The lateral retinaculum contributed to patellar stability throughout the entirety of knee flexion. Quadriceps angle altered patellar orientation during knee flexion, but not extension. Whilst vastus medialis obliquus strength was found to be a determinant of patellar stability, there is conflicting evidence regarding the effect of VMO morphological parameters on patellar stability. The lateral retinaculum provided stability throughout the entirety of knee flexion, and the medial retinaculum did so up to 30° of flexion.