Bony and cartilaginous anatomy of the patellofemoral joint

Tecklenburg, Katja; Dejour, David; Hoser, Christian; Fink, Christian

doi:10.1007/s00167-005-0683-0

Cited by 221 publications

(168 citation statements)

References 32 publications

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“…The lateral restraint, on the other hand, dropped at 208 flexion, then rose thereafter but to a lesser degree than the medial restraint. It is generally thought that the trochlear groove deepens in flexion and that the lateral facet is steeper and more prominent than the medial, 21 so the contrasting data in this study suggested an important role for the soft tissues in restraining patellar medial-lateral translations.…”

Section: Discussioncontrasting

confidence: 56%

Iliotibial band tension reduces patellar lateral stability

Merican

Iranpour

Amis

2009

Journal Orthopaedic Research

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This study investigated the effect of loading the iliotibial band (ITB) on the stability of the patellofemoral joint. We measured the restraining force required to displace the patella 10 mm medially and laterally (defined as medial and lateral stability, respectively) in 14 fresh-frozen knees from 0 to 908 knee flexion. The testing rig allowed the patella to rotate and translate freely during this displacement. The quadriceps was separated into five components and loaded with 175 N total tension. Testing was performed at 0 to 90 N ITB tension. With no ITB tension, the lateral restraining force ranged from 82 to 101 N across 0 to 908 flexion. Increasing ITB tension caused progressive reduction of the lateral restraining force. The maximum reduction was 25% at 608 flexion and 90 N ITB tension. Medial restraining force increased progressively with increasing knee flexion and increasing ITB loads; it ranged from 74 N at 08 knee flexion and 0 N ITB tension to 211 N at 908 knee flexion and 90 N ITB tension. The maximum effect was an increase of medial restraining force of 50% at 908 flexion and 90 N ITB tension. ß

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Section: Discussioncontrasting

confidence: 56%

Iliotibial band tension reduces patellar lateral stability

Merican

Iranpour

Amis

2009

Journal Orthopaedic Research

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“…In addition, we found that cartilage stress plateaued when patella height had been corrected close to normal (InsallSalvati ratio approximately 1.0); further distalization did not provide lower values. Clinically, a low-lying patella or elevated tibiofemoral joint line also may lead to several complications such as joint stiffness, decreased ROM, and anterior knee pain [11,14,28]. Therefore, we advocate proper distalization of the tibial tubercle to correct the Insall-Salvati ratio to normal.…”

Section: Discussionmentioning

confidence: 99%

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Liao

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patellofemoral malalignment associated with patella alta may cause pain and arthritis; because of this, the condition sometimes is treated surgically. Two common procedures are tibial tubercle distalization with or without patellar tendon tenodesis. However, the biomechanical consequences of these interventions for patella alta are not clearly understood. Questions/purposes We evaluated changes in patellofemoral joint contact mechanics after tibial tubercle distalization and tibial tubercle distalization combined with patella tendon tenodesis. Specifically, we asked: (1) Are there biomechanical differences between these two types of procedures? (2) Is there an ideal range to distalize the patella? Methods Subject-specific finite-element models were created for 10 individuals with patella alta (mean InsallSalvati ratio of 1.34 ± 0.05). Input parameters for the finite-element models included subject-specific joint geometry, quadriceps muscle forces, and weightbearing patellofemoral joint kinematics. Virtual operations were conducted to simulate the two procedures. For distalization, the tibial tubercle and patella were displaced distally 4 mm to 20 mm in 4-mm increments based on the original model. At each level of distalization, the patella tendon was attached back to its original insertion to simulate the additional tenodesis procedure. Cartilage stress, contact area, and contact forces were quantified and compared between procedures and distalization levels. Results Distalization and distalization + tenodesis reduced patellofemoral joint stress compared with the baseline of 1.02 ± 0.11 MPa. Distalization led to lower cartilage stress than distalization + tenodesis, and the effect size was relatively large (0.88 ± 0. Conclusions Cartilage stress appears lower using distalization as opposed to distalization + tenodesis in this finite-element analysis simulation. An Insall-Salvati ratio of 0.95 may be an ideal level for distalization; further distalization does not show additional benefits. Clinical Relevance This study suggests that distalization may result in less stress than distalization + tenodesis,

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“…This is because femoral side OA in the PF joint is strongly influenced by tibio-femoral OA [26,27]. To eliminate the bias of other factors, only patella OA lesions were evaluated in this study.…”

Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament deterioration correlates with patella osteoarthritis

Iriuchishima¹,

Ryu

Aizawa

et al. 2013

International Orthopaedics (SICOT)

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Purpose The correlation between anterior cruciate ligament (ACL) condition and patella osteoarthritic (OA) changes has not been well reported. The aim of this study was to reveal the correlation between ACL deterioration and the morphology of OA changes in the patella. The hypothesis was that significant correlation between ACL deterioration and patella OA morphology would be revealed in this study. Methods Two hundred ninety-one cadaveric knees from 151 cadavers were included in this study with a median age of 83 years (54-98). Knees were opened with a sub-vastus approach and the ACL condition was classified as intact or deteriorated. Patella OA lesions were classified using Han's method: type 1, no or minimal lesion; type 2, medial facet lesion without involvement of the ridge; type 3, lateral facet lesion without involvement of the ridge; type 4, lesion involving the ridge only; type 5, medial facet lesion with involvement of the ridge; type 6, lateral facet lesion with involvement of the ridge; and type 7, global lesion. OA depth evaluation was performed following Outerbridge's classification. Statistical analysis of the collected data was performed using generalized estimating equations (GEE). Results The ACL was intact in 277 knees and deteriorated in 14 knees. Patella OA lesions were observed as follows: type 1, 29 %; type 2, 15 %; type 3, 2 %; type 4, 12 %; type 5, 18 %; type 6, 2 %; and type 7, 22 %. Outerbridge's classification of over grade 2 OA depth was observed in 73.5 % of subjects. When patella OA was divided into types 1-4 and types 5-7, ACL deterioration was correlated with the occurrence of type 5-7 patella OA [OR 6.44, 95%CI 2.27-18.25, p =0.000]. When patella OA was divided into types 1-6 and type 7, ACL deterioration was correlated with the occurrence of type 7 patella OA [OR 6.02, p =0.000]. When patella OA depth was divided into grades 1-3 and grade 4, ACL deterioration was highly correlated with the occurrence of grade 4 patella OA [OR 9.31, p =0.025]. Conclusion ACL deterioration is a strong risk factor of wider and deeper OA changes in the patella. For clinical relevance, subjects with ACL tear should be aware of the progression of patella OA.

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Bony and cartilaginous anatomy of the patellofemoral joint

Cited by 221 publications

References 32 publications

Iliotibial band tension reduces patellar lateral stability

Iliotibial band tension reduces patellar lateral stability

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Anterior cruciate ligament deterioration correlates with patella osteoarthritis

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