Abstract
This study investigated the anatomy of the structures that form the extensor mechanism of the knee joint using microsurgical techniques. Ten fresh-frozen human adult cadaveric knees were used. The quadriceps components, the infrapatellar tendon, the patellofemoral ligaments, and their relations to the neighboring anatomical structures were measured. The angles of the vastus lateralis and the vastus medialis muscle fibers to the rectus tendon were 26.6 and 41.1°, respectively. The medial patellofemoral ligament connecting the femoral medial epicondyle to the medial edge of the patella was approximately 54.2 mm long, and its width ranged from 9 to 30 mm. The medial patellomeniscal ligament had a wide attachment to the meniscus whereas the attachment to the patella was narrow. The patellar tendon was 31.9 mm broad at its attachment to the apex of the patella and 27.4 mm wide at its attachment to the tibial tubercle. It was 38–49 mm long. Using the surgical microscope we were able to dissect and identify a trilaminar arrangement of prepatellar fibrous soft tissues. Also, we were able to identify the vessels and nerves around the patella. Details of clinical relevance and the possible pathological implications of the material presented are discussed. Emphasis is placed on the stability of the patellofemoral joint and the complex interaction between a range of factors providing it.
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Adler N, Perry B, Kent B, Robertson K (1983) Electromyography of the vastus medialis oblique and vasti in normal subjects during gait. Electromyogr Clin Neurophysiol 233:643–649
Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220
Beasley LS, Vidal AF (2004) Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr 16(1):29–36
Bose K, Kanagasuntheram R, Osman MBH (1980) Vastus medialis oblique: an anatomic and physiologic study. Orthopaedics 3:880–883
Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75(5):682–693
Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26(1):59–65
Diamantopoulos A, Tokis A, Tzurbakis M, Patsopoulos I, Georgoulis A (in press) The posterolateral corner of the knee: evaluation under microsurgical dissection. Arthroscopy (in press)
Dye SF, Campagna-Pinto D, Dye CC, Shifflett S, Eiman T (2003) Soft-tissue anatomy anterior to the human patella. J Bone Joint Surg Am 85A(6):1012–1017
Farahmand F, Tahmasbi NM, Amis AA (2004) The contribution of the medial retinaculum and quadriceps muscles to patellar lateral stability—an in-vitro study. Knee (11):89–94
Feller JA, Feagin JA Jr, Garrett WE Jr (1993) The medial patellofemoral ligament revisited: an anatomical study. Knee Surg Sports Traumatol Arthrosc 1(3–4):184–186
Fithian DC, Paxton EW, Cohen AB (2004) Indications in the treatment of patellar instability. J Knee Surg 1(1):47–56
Fulkerson JP, Hungerford DS (1990) Disorders of the patellofemoral joint, 2nd edn. Williams & Wilkins, Baltimore
Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM (1998) Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop 349:174–182
Hubbard KJ, Sampson HW, Elledge JR (1997) Prevalence and morphology of the vastus medialis oblique muscle in human cadavers. Anat Rec 249:135–142
Hughston JC (1968) Subluxation of the patella. J Bone Joint Surg Am 50:1003–1026
Jeffreys TE (1963) Recurrent dislocation of the patella due to abnormal attachment of the ilio-tibial tract. J Bone Joint Surg Br 45:740–743
Kaplan EB (1962) Some aspects of functional anatomy of the human knee joint. Clin Orthop 23:18–29
Koskinen SK, Kujala UM (1992) Patellofemoral relationships and distal insertion of the vastus medialis muscle: a magnetic resonance imaging study in nonsymptomatic subjects and in patients with patellar dislocation. Arthroscopy 8(4):465–468
Lieb FJ, Perry J (1968) Quadriceps function. an anatomical and mechanical study using amputated limbs. J Bone Joint Surg 50:1535–1548
MacNab I (1952) Recurrent dislocation of the patella. J Bone Joint Surg Am 34:957–967
Makris CA, Georgoulis AD, Papageorgiou CD, Moebius UG, Soucacos PN (2000) Posterior cruciate ligament architecture: evaluation under microsurgical dissection. Arthroscopy 16(6):627–632
Merchant AO (1988) Classification of patellofemoral disorders. Arthroscopy 4(4):235–240
Mont MA, Rajadhyaksha AD, Low K, LaPorte DM, Hungerford DS (2001) Anatomy of the knee extensor mechanism: correlation with patellofemoral arthrosis. J South Orthop Assoc 10(1):24–31
Ober FR (1939) Recurrent dislocation of the patella. Am J Surg 43:497
Reider B, Marshall J, Koslin B, Ring B, Girgis F (1981) The anterior aspect of the knee joint. J Bone Joint Surg 63A:351–356
Sakai N, Luo Z, Rand J, An K (2000) The influence of weakness in the vastus medialis oblique muscle on the patellofemoral joint: an in vitro biomechanical study. Clin Biomechanics 15:335–339
Salzman A, Torburn L, Perry J (1993) Contribution of rectus femoris and vasti to knee extension. An electromyographic study. Clin Orthop 290:236–243
Senavongse W, Farahmand F, Jones J, Andersen H, Bull AM, Amis AA (2003) Quantitative measurement of patellofemoral joint stability: force-displacement behavior of the human patella in vitro. J Orthop Res 21(5):780–786
Scapinelli R (1967) Blood supply of the human patella. Its relation to ischaemic necrosis after fracture. J Bone Joint Surg Br 49(3):563–570
Smillie IS (1951) Injuries of the knee joint.2nd edn. E & S Livingstone, Edinburgh, p 249
Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10(3):221–227
Soldado F, Reina F, Yuguero M, Rodriquez-Baeza A (2002) Clinical anatomy of the arterial supply of the human patellar ligament. Surg Radiol Anat 24(3–4):177–182
Speakman HG, Weisberg J (1977) The vastus medialis controversy. Physiotherapy 63:249–254
Suzuki S (1987) The role of the quadriceps muscle for the patellofemoral malalignment syndrome. J Jpn Orthop Assoc 61:905–916
Tanner SM, Garth Jr WP, Soileau R, Lemons JE (2003) A modified test for patellar instability: the biomechanical basis. Clin J Sport Med 13(6):327–338
Terry GC (1989) The anatomy of the extensor mechanism. Clin Sport Med 8(2):163–177
Tifford CD, Spero L, Luke T, Plancher KD (2000) The relationship of the infrapatellar branches of the saphenous nerve to arthroscopy portals and incisions for anterior cruciate ligament surgery. An anatomic study. Am J Sports Med 28(4):562–567
Tuxoe IJ, Teir M, Winge S, Nielsen LP (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10(2):96–101
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Andrikoula, S., Tokis, A., Vasiliadis, H.S. et al. The extensor mechanism of the knee joint: an anatomical study. Knee Surg Sports Traumatol Arthrosc 14, 214–220 (2006). https://doi.org/10.1007/s00167-005-0680-3
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DOI: https://doi.org/10.1007/s00167-005-0680-3