The innervation of patella: anatomical and clinical study

Abstract

As much interest has been focused on afferent innervation of knee than that of patella, there are few articles about patellar innervation. But in clinical practice anterior knee pain due to patellar disorders is a quite frequent problem. Our aim was to review the innervation pattern of patella and to give the topographic anatomy of the nerves. We dissected 30 knees of 15 formaldehyde-fixed cadavers. Two nerves from vastus medialis and lateralis were found to reach patellar edge. Apart from these, we were unable to find any other neural structures around patellae. Mean distances between the tuberosity of the tibia and medial and lateral nerve entry points were 90.1(range 74-102) and 96.3 mm (range 76-109), respectively. The angles between lines which join the entry points of nerves and vertical line to the center point of patella were measured in frontal plane. It was approximately 60 degrees medially and 40 degrees laterally. To confirm that these nerves are patellar pain afferents, we performed a local anesthesia test in 32 knees of 20 patients with patellofemoral pain. Clinically, there was a significant difference between the visual analogue scale (VAS) scores before and after local anesthetic injections (p<0.01). Previous studies have emphasized especially the medial innervation. We found that both superomedial and superolateral nerves were important for patellar innervation. We described precisely the entry points of these nerves to patella for selective denervation.

Neurodynamic Responses to the Femoral Slump Test in Patients With Anterior Knee Pain Syndrome

“…The location of the FST-induced discomfort/tightness (the anterior thigh) was in agreement with results shown by Lai et al 13,14 The FST-reproduced patellar pain in patients with a positive FST was mainly located at the superior rim of the patella (FIGURE 2). As the medial and lateral patellar nerves enter the patella from its medial-and lateral-superior border, 18 this location of nerve entrance was consistent with the location of the reproduced anterior knee pain during the FST.…”

“…Maralcan et al 18 showed that the femoral nerve played an important role in patellofemoral pain symptoms by giving local anesthetic injections to the medial and lateral patellar nerves in 20 patients with anterior knee pain, which significantly reduced the pain intensity. The femoral slump test (FST) is a neurodynamic test that can be used to assess the femoral component of the nervous system.…”

Is patellar denervation necessary in total knee arthroplasty without patellar resurfacing?

“…Definitely, Maralcan et al [17] reported that the patella had two nerve supplies, to the superomedial quadrants and to the superolateral quadrants, coursing within the substance of the vastus medialis and lateralis. The discovery could provide an anatomical evidence for orthopaedic surgeon.…”

Partial Knee Joint Denervation for Knee Pain: A Review

“…I would interpret their anatomic study in the fixed cadavers as confirming our observations reported in 1994. These authors then went on to confirm that these nerves are patellar pain afferents, by performing a local anesthesia block in 32 knees of 20 patients with patellofemoral pain [28]. They observed a significant difference between the visual analogue scale (VAS) scores before and after local anesthetic injections (p<0.01).…”

“…A recent study, from Turkey, evaluated the innervation of the patella in 30 knees of 15 formaldehyde-fixed cadavers [28]. A nerve from the vastus medialis, which is the nerve described above [1], entering the patella "superomedially", and a nerve "from the vastus lateralis, entering the patella superolaterally" were identified.…”