MQTFL

For Medical Students

Structure and Location

The medial quadriceps tendon femoral ligament runs from the same femoral area as the medial patellofemoral ligament to the deep surface of the quadriceps tendon, just above the patella.

It is the part of the medial restraint that attaches to tendon instead of to the patella itself.

Conventional teaching places its attachment on the deep surface of the distal quadriceps tendon over a span of about 20 mm, ending at the top of the patella.

The two structures share a femoral origin and separate as they run forwards, so they are often described together as the medial patellofemoral complex.

Whether it is a separate ligament or the proximal part of one sheet is argued, in the same way and for the same reason as the anterolateral ligament in 2.11.3.

Relations

Above and in front: the quadriceps tendon, into whose deep surface it inserts.

Below: the medial patellofemoral ligament proper, running to the patellar border.

Behind: the femoral attachment they share, between the adductor tubercle and the medial epicondyle.

Superficial: vastus medialis obliquus, which overlies the whole complex.

Function

It restrains lateral movement of the patella, in the same direction and through the same range as the medial patellofemoral ligament.

Because it attaches to tendon, its tension changes with quadriceps contraction as well as with knee position.

Together the two structures form one restraint acting over a span from the quadriceps tendon to the mid medial patellar border.

Clinical Relevance

Its existence is why a reconstruction can be fixed to the quadriceps tendon rather than to the patella, which avoids drilling a small and sometimes fragile bone.

A tendon attachment means the restraint is partly dynamic, which no bone attachment is.

7.51 covers reconstruction. This page covers what is there to reconstruct.

MRCS Level

Structure and Location

Describe the medial patellofemoral complex as one fan from a small femoral origin to a broad anterior attachment, part on tendon and part on bone. The two names divide the fan by where it lands.

The femoral origin is shared and small. Conventional teaching places it in the same saddle 2.12.2 describes, which is why a single graft can reproduce both.

The tendon attachment is to the deep surface and is easily missed from outside, because it is covered by the tendon it attaches to.

Identification rates differ between studies for the same reason they do at the anterolateral knee: the dissection decides what is found.

Relations

It lies in layer two with the medial patellofemoral ligament, deep to vastus medialis obliquus and superficial to the capsule.

The adductor tubercle is the landmark for its femoral end, as for the ligament below it.

The quadriceps tendon's deep surface is the landmark for its anterior end, about 20 mm proximal to the patellar pole.

The suprapatellar pouch lies deep to it, so an attachment on the tendon's undersurface sits directly over synovium.

Blood Supply and Innervation

Supply is shared with the medial patellofemoral ligament, from the descending genicular and medial genicular arteries.

The quadriceps tendon end has the better supply of the two, which is relevant where a graft is fixed there.

Nerve supply is from the medial articular branches.

Function

Its contribution to lateral restraint is additive with the ligament below it, and the two have not been reliably separated experimentally.

Its tendon attachment makes part of the restraint dependent on quadriceps tone, so the complex is not purely passive.

Its line of pull is more proximal than the ligament's, so it acts on the patella through the tendon rather than directly.

Clinical Relevance

Consider a quadriceps tendon fixation where the patella is small, osteopenic or previously drilled, and 7.51 carries the technique.

Expect a tendon fixation to behave slightly differently from a patellar one, because the attachment is dynamic rather than fixed.

Avoid treating the two structures as alternatives. The anatomy is one fan and a reconstruction reproduces part of it wherever it is fixed.

Identify the femoral point once. It serves both structures, which is the practical consequence of the shared origin.

FRCS Level

Relations

The shared femoral origin is the anatomy that matters most, because it means the accuracy requirement is the same whichever anterior attachment a graft uses.

The tendon's deep surface sits over the suprapatellar pouch, so a fixation there passes close to synovium rather than to bone.

The complex has no clean posterior border with the retinaculum, which 2.12.4 covers.

Function

Treat the complex as one restraint with two anterior attachments rather than as two ligaments. The experimental literature has not separated them and the operation does not need them separated.

The dynamic element from the tendon attachment is small and real. A construct fixed only to bone reproduces a restraint that does not change with quadriceps tone.

Length behaviour is set at the femur for both, so a correct femoral point serves either fixation and an incorrect one ruins both.

Clinical Relevance

Choose the anterior fixation by the patella's condition rather than by preference for a named structure.

Confirm the femoral point radiographically whichever anterior attachment is used, because that is where the error lives. 2.12.6 covers the landmarks.

Consider a tendon fixation in a patella that has already been drilled, since a second tunnel in a small bone is a fracture risk.

Avoid describing a construct as anatomical for one structure when the femoral point is shared. The accuracy claim belongs to the femur.

Fellowship Level

Clinical Relevance

The named structure is less useful than the shared origin. Whether a construct is called a patellofemoral or a quadriceps tendon femoral reconstruction, the femoral point decides its length behaviour, and that point is the same for both. Accuracy arguments about the anterior end are arguments about the less important end.

Patellar fixation has a cost the tendon fixation does not. A small, previously drilled or osteopenic patella takes a second tunnel badly, and patellar fracture after reconstruction is a complication of bone rather than of ligament. Where that risk is present the tendon attachment is anatomy rather than improvisation.

The dynamic element is small and worth knowing about rather than relying on. A tendon attachment changes tension with quadriceps contraction, which a graft to bone does not, and in a knee with poor quadriceps control neither reproduces much.

Over-tensioning is the shared failure mode. The complex is a check that is unloaded in normal tracking, so a construct tensioned to hold the patella rather than to stop it escaping loads the medial facet every step. 3.12.3 carries contact pressure.

Neither structure corrects bone. A patella that dislocates because of trochlear geometry or tubercle position is not held by a 1 mm sheet, and the anatomy says that before any trial does.