The Basic Science of the Patella: Structure, Composition, and Function

Abstract

The patella is the largest sesamoid bone in the body. The patellofemoral joint provides an integral articulating component of the extensor mechanism of the knee joint. A detailed description of patella anatomy, embryology and development, neurovascular anatomy, biomechanical function, and imaging modalities is provided in this article. Common patellar pathologies such as patellar instability, trochlear dysplasia, patella alta and baja, and patellofemoral joint arthritis as well as patellofemoral arthroplasty as a treatment option are also discussed. An understanding of the normal anatomy and biomechanics of the patella is a necessary prerequisite for understanding the pathogenesis of disorders involving the knee.

Keywords

patella - basic science - anatomy - patellofemoral joint - biomechanics

• References

• 1 Freehafer AA. A study of the function of the patella. Clin Orthop Relat Res 1962; 25: 162-167
• 2 Kaufer H. Mechanical function of the patella. J Bone Joint Surg Am 1971; 53 (8) 1551-1560
• 3 Ahmed AM, Burke DL, Hyder A. Force analysis of the patellar mechanism. J Orthop Res 1987; 5 (1) 69-85
• 4 Grabiner MD, Koh TJ, Draganich LF. Neuromechanics of the patellofemoral joint. Med Sci Sports Exerc 1994; 26 (1) 10-21
• 5 Ficat R. Pathologie Femoro–Patellaire. Paris: Masson et Cie; 1970
• 6 Andersen H. Histochemical studies on the histogenesis of the knee joint and superior tibio-fibular joint in human foetuses. Acta Anat (Basel) 1961; 46: 279-303
• 7 Gardner E, O'Rahilly R. The early development of the knee joint in staged human embryos. J Anat 1980; (102) 289-299
• 8 Hall BK. Fins into Limbs: Evolution, Development and Transformation. Chicago, IL: University of Chicago Press; 2007
• 9 Mérida-Velasco JA, Sánchez-Montesinos I, Espín-Ferra J, Mérida-Velasco JR, Rodríguez-Vázquez JF, Jiménez-Collado J. Development of the human knee joint ligaments. Anat Rec 1997; 248 (2) 259-268
• 10 Bernays A. Die entwicklungsgeschichte des kniegelenkes des menschen. Morph 1878; JB: 4
• 11 Walmsley R. The development of the patella. J Anat 1940; 74 (Pt 3) 360-368
• 12 Gray DJ, Gardner E. Prenatal development of the human knee and superior tibiofibular joints. Am J Anat 1950; 86 (2) 235-287
• 13 Fulkerson JP, Buuck DA. Disorders of the Patellofemoral Joint. 4th ed. Baltimore: Lippincott Williams & Wilkins; 2004
• 14 Koyuncu E, Cankara N, Sulak O, Özgüner G, Albay S. The morphometry of patella and patellar ligament during the fetal period. Clin Anat 2011; 24 (2) 225-231
• 15 Ogden JA. Radiology of postnatal skeletal development. X. Patella and tibial tuberosity. Skeletal Radiol 1984; 11 (4) 246-257
• 16 Ogden JA. Skeletal Injury in the Child. 3rd ed. New York: Springer-Verlag; 2000
• 17 Callaghan JJ. The Adult Knee. Baltimore: Lippincott Williams & Wilkins; 2003
• 18 Matthews BF. Composition of articular cartilage in osteoarthritis; changes in collagen/chondroitin-sulphate ratio. BMJ 1953; 2 (4837) 660-661
• 19 Reider B, Marshall JL, Koslin B, Ring B, Girgis FG. The anterior aspect of the knee joint. J Bone Joint Surg Am 1981; 63 (3) 351-356
• 20 Eckstein F, Glaser C. Measuring cartilage morphology with quantitative magnetic resonance imaging. Semin Musculoskelet Radiol 2004; 8 (4) 329-353
• 21 Draper CE, Besier TF, Gold GE , et al. Is cartilage thickness different in young subjects with and without patellofemoral pain?. Osteoarthritis Cartilage 2006; 14 (9) 931-937
• 22 Mankin HJ, Thrasher AZ. Water content and binding in normal and osteoarthritic human cartilage. J Bone Joint Surg Am 1975; 57 (1) 76-80
• 23 Maroudas A. Physicochemical Properties of Articular Cartilage. Pitman Medical Publishers; 1979
• 24 Mow VC, Kuei SC, Lai WM, Armstrong CG. Biphasic creep and stress relaxation of articular cartilage in compression? Theory and experiments. J Biomech Eng 1980; 102 (1) 73-84
• 25 Armstrong CG, Mow VC. Variations in the intrinsic mechanical properties of human articular cartilage with age, degeneration, and water content. J Bone Joint Surg Am 1982; 64 (1) 88-94
• 26 Buckwalter JA, Hunziker E, Rosenberg L , et al. Articular Cartilage: Composition and Structure. Park Ridge, IL: AAOS; 1988
• 27 Mankin HJ, Mow VC, Buckwalter JA, Ianotti JP, Ratcliffe A. Structure and function of articular cartilage. Orthopaedic Basic Science: Rosemont IL, AAOS; 1994: 1-44
• 28 Buckwalter JA, Mankin HJ. Articular cartilage: tissue design and chondrocyte-matrix interactions. Instr Course Lect 1998; 47: 477-486
• 29 Stäubli HU, Dürrenmatt U, Porcellini B, Rauschning W. Anatomy and surface geometry of the patellofemoral joint in the axial plane. J Bone Joint Surg Br 1999; 81 (3) 452-458
• 30 Wiberg G. Roentgenographic and anatomic studies on the femoro-patellar joint. Acta Orthop Scand 1941; (12) 319-410
• 31 Tecklenburg K, Dejour D, Hoser C, Fink C. Bony and cartilaginous anatomy of the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 2006; 14 (3) 235-240
• 32 Kwak SD, Colman WW, Ateshian GA, Grelsamer RP, Henry JH, Mow VC. Anatomy of the human patellofemoral joint articular cartilage: surface curvature analysis. J Orthop Res 1997; 15 (3) 468-472
• 33 DePalma AF. Diseases of the Knee. Philadelphia: JB Lippincott; 1954
• 34 Watanabe M, Helfet A eds. Disorders of the Knee. Philadelphia: JB Lippincott; 1974
• 35 Emery IH, Meachim G. Surface morphology and topography of patello-femoral cartilage fibrillation in Liverpool necropsies. J Anat 1973; 116 (Pt 1) 103-120
• 36 Ficat C. La degenerescence du cartilage de la rotule. De la chondromalacie a l'arthrose. Semin Hosp (Paris) 1974; 50: 3201-3209
• 37 Tavernier T, Dejour D. [Knee imaging: what is the best modality]. J Radiol 2001; 82 (3 Pt 2) 387-405 , 407–408
• 38 Groves EWH. A note on the extension apparatus of the knee-joint. Br J Surg 1937; (24) 747-748
• 39 Stannard JP, Schmidt AH, Kregor PJ. Surgical Treatment of Orthopaedic Trauma. New York: Thieme; 2007
• 40 Feller JA, Feagin Jr JA, Garrett Jr WE. The medial patellofemoral ligament revisited: an anatomical study. Knee Surg Sports Traumatol Arthrosc 1993; 1 (3-4) 184-186
• 41 Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 1979; 61 (1) 56-62
• 42 Ahmad CS, Stein BE, Matuz D, Henry JH. Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases. Am J Sports Med 2000; 28 (6) 804-810
• 43 Nomura E, Inoue M, Osada N. Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 2005; 13 (7) 510-515
• 44 Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998; 26 (1) 59-65
• 45 Conlan T, Garth Jr WP, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 1993; 75 (5) 682-693
• 46 Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 1998; (349) 174-182
• 47 Ahmad CS, McCarthy M, Gomez JA, Shubin Stein BE. The moving patellar apprehension test for lateral patellar instability. Am J Sports Med 2009; 37 (4) 791-796
• 48 Lee TQ, Yang BY, Sandusky MD, McMahon PJ. The effects of tibial rotation on the patellofemoral joint: assessment of the changes in in situ strain in the peripatellar retinaculum and the patellofemoral contact pressures and areas. J Rehabil Res Dev 2001; 38 (5) 463-469
• 49 Larsen E, Lauridsen F. Conservative treatment of patellar dislocations. Influence of evident factors on the tendency to redislocation and the therapeutic result. Clin Orthop Relat Res 1982; (171) 131-136
• 50 Garth Jr WP, DiChristina DG, Holt G. Delayed proximal repair and distal realignment after patellar dislocation. Clin Orthop Relat Res 2000; (377) 132-144
• 51 Beasley LS, Vidal AF. Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr 2004; 16 (1) 29-36
• 52 Bicos J, Fulkerson JP, Amis A. Current concepts review: the medial patellofemoral ligament. Am J Sports Med 2007; 35 (3) 484-492
• 53 Shim SS, Leung G. Blood supply of the knee joint. A microangiographic study in children and adults. Clin Orthop Relat Res 1986; (208) 119-125
• 54 Bucholz RW, Court-Brown C, Heckman JD. Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2009
• 55 Crock HV. The arterial supply and venous drainage of the bones of the human knee joint. Anat Rec 1962; 144: 199-217
• 56 Scapinelli R. Blood supply of the human patella. Its relation to ischaemic necrosis after fracture. J Bone Joint Surg Br 1967; 49 (3) 563-570
• 57 Malek MM. Knee Surgery: Complications, Pitfalls, and Salvage. New York: Springer; 2001
• 58 Horner G, Dellon AL. Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res 1994; (301) 221-226
• 59 Scuderi GR, Kibiuk LV, Insall JN. The Patella. New York: Springer-Verlag; 1995
• 60 Grelsamer RP, Weinstein CH. Applied biomechanics of the patella. Clin Orthop Relat Res 2001; (389) 9-14
• 61 Bellemans J. Biomechanics of anterior knee pain. Knee 2003; 10 (2) 123-126
• 62 Sears FW, Zemansky MWRM. University Physics. Reading: Addison-Wesley; 1970: 30-31
• 63 Browner BD, Levine AM, Jupiter JB, Trafton PG, Krettek C. Skeletal Trauma. 4th ed. Philadelphia: Saunders; 2009
• 64 Lieb FJ, Perry J. Quadriceps function. An anatomical and mechanical study using amputated limbs. J Bone Joint Surg Am 1968; 50 (8) 1535-1548
• 65 Grelsamer RP, Proctor CS, Bazos AN. Evaluation of patellar shape in the sagittal plane. A clinical analysis. Am J Sports Med 1994; 22 (1) 61-66
• 66 Mow VC, Flatow EL, Ateshian GA. Biomechanics. In: Buckwalter JA, Einhorn TA, Simon SR, eds. Orthopaedic Basic Science. Springfield, IL: American Academy of Orthopaedic Surgeons; 2000: 133-146
• 67 Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am 1984; 66 (5) 715-724
• 68 Goodfellow J, Hungerford DS, Zindel M. Patello-femoral joint mechanics and pathology. 1. Functional anatomy of the patello-femoral joint. J Bone Joint Surg Br 1976; 58 (3) 287-290
• 69 Fox JM, Del Pizzo WD. The Patellofemoral Joint. New York: McGraw-Hill; 1993
• 70 Wendt PP, Johnson RP. A study of quadriceps excursion, torque, and the effect of patellectomy on cadaver knees. J Bone Joint Surg Am 1985; 67 (5) 726-732
• 71 Chen SC, Ramanathan EB. The treatment of patellar instability by lateral release. J Bone Joint Surg Br 1984; 66 (3) 344-348
• 72 Insall JN. Disorders of the Patella, Surgery of the Knee. New York: Churchill Livingstone; 1984
• 73 Insall J, Falvo KA, Wise DW. Chondromalacia patellae. A prospective study. J Bone Joint Surg Am 1976; 58 (1) 1-8
• 74 Livingston LA. The quadriceps angle: a review of the literature. J Orthop Sports Phys Ther 1998; 28 (2) 105-109
• 75 Wilson T, Kitsell F. Is the Q-angle an absolute or variable measure?. Physiotherapy 2002; (88) 293-302
• 76 France L, Nester C. Effect of errors in the identification of anatomical landmarks on the accuracy of Q angle values. Clin Biomech (Bristol, Avon) 2001; 16 (8) 710-713
• 77 Herrington L, Nester C. Q-angle undervalued? The relationship between Q-angle and medio-lateral position of the patella. Clin Biomech (Bristol, Avon) 2004; 19 (10) 1070-1073
• 78 Hungerford DS, Barry M. Biomechanics of the patellofemoral joint. Clin Orthop Relat Res 1979; (144) 9-15
• 79 Davies AM, Cassar-Pullicino VN. Imaging of the Knee: Techniques and Applications. New York: Springer; 2003
• 80 McGinnis PM. Biomechanics of Sports and Exercise. Champaign, IL: Human Kinetics; 2005
• 81 Amis AA. Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc 2007; 15 (2) 48-56
• 82 Katchburian MV, Bull AM, Shih YF, Heatley FW, Amis AA. Measurement of patellar tracking: assessment and analysis of the literature. Clin Orthop Relat Res 2003; (412) 241-259
• 83 Heegaard J, Leyvraz PF, Curnier A, Rakotomanana L, Huiskes R. The biomechanics of the human patella during passive knee flexion. J Biomech 1995; 28 (11) 1265-1279
• 84 Heegaard J, Leyvraz PF, Van Kampen A, Rakotomanana L, Rubin PJ, Blankevoort L. Influence of soft structures on patellar three-dimensional tracking. Clin Orthop Relat Res 1994; (299) 235-243
• 85 Thomeé R, Augustsson J, Karlsson J. Patellofemoral pain syndrome: a review of current issues. Sports Med 1999; 28 (4) 245-262
• 86 Grelsamer RP. Patellar malalignment. J Bone Joint Surg Am 2000; 82–A (11) 1639-1650
• 87 Kwak SD, Ahmad CS, Gardner TR , et al. Hamstrings and iliotibial band forces affect knee kinematics and contact pattern. J Orthop Res 2000; 18 (1) 101-108
• 88 Moro-oka T, Matsuda S, Miura H , et al. Patellar tracking and patellofemoral geometry in deep knee flexion. Clin Orthop Relat Res 2002; (394) 161-168
• 89 Shih YF, Bull AM, McGregor AH, Amis AA. Active patellar tracking measurement: a novel device using ultrasound. Am J Sports Med 2004; 32 (5) 1209-1217
• 90 Fulkerson JP, Shea KP. Disorders of patellofemoral alignment. J Bone Joint Surg Am 1990; 72 (9) 1424-1429
• 91 Johnson RJ, Pope MH. Knee joint stability without reference to ligamentous function. AAOS Symposium on Reconstructive Surgery of the Knee; 1978; (2:14)
• 92 Insall J. “Chondromalacia patellae”: patellar malalignment syndrome. Orthop Clin North Am 1979; 10 (1) 117-127
• 93 Micheli LJ, Slater JA, Woods E, Gerbino PG. Patella alta and the adolescent growth spurt. Clin Orthop Relat Res 1986; (213) 159-162
• 94 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (1) 19-26
• 95 Senavongse W, Farahmand F, Jones J, Andersen H, Bull AM, Amis AA. Quantitative measurement of patellofemoral joint stability: force-displacement behavior of the human patella in vitro. J Orthop Res 2003; 21 (5) 780-786
• 96 Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability. J Bone Joint Surg Br 2005; 87 (4) 577-582
• 97 Biedert RM. Patellofemoral Disorders: Diagnosis and Treatment. New York: John Wiley & Sons; 2004
• 98 McConnell J. Rehabilitation and nonoperative treatment of patellar instability. Sports Med Arthrosc 2007; 15 (2) 95-104
• 99 Fulkerson JP, Hungerford D. Disorders of the Patellofemoral Joint. 2nd ed. Baltimore: Williams & Wilkins; 1990
• 100 Hughston JC. Subluxation of the patella. J Bone Joint Surg Am 1968; 50 (5) 1003-1026
• 101 Hanten WP, Schulthies SS. Exercise effect on electromyographic activity of the vastus medialis oblique and vastus lateralis muscles. Phys Ther 1990; 70 (9) 561-565
• 102 Hehne HJ. Biomechanics of the patellofemoral joint and its clinical relevance. Clin Orthop Relat Res 1990; (258) 73-85
• 103 Taşkiran E, Dinedurga Z, Yağiz A, Uludağ B, Ertekin C, Lök V. Effect of the vastus medialis obliquus on the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 1998; 6 (3) 173-180
• 104 Mirzabeigi E, Jordan C, Gronley JK, Rockowitz NL, Perry J. Isolation of the vastus medialis oblique muscle during exercise. Am J Sports Med 1999; 27 (1) 50-53
• 105 Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003; 10 (3) 215-220
• 106 Bose K, Kanagasuntheram R, Osman MBH. Vastus medialis obliquus: an anatomic and physiologic study. Orthopaedics 1980; 3: 880-883
• 107 Raimondo RA, Ahmad CS, Blankevoort L, April EW, Grelsamer RP, Henry JH. Patellar stabilization: a quantitative evaluation of the vastus medialis obliquus muscle. Orthopedics 1998; 21 (7) 791-795
• 108 Scharf W, Weinstabl R, Orthner E. [Anatomical separation and clinical importance of two different parts of the vastus medialis muscle]. Acta Anat (Basel) 1985; 123 (2) 108-111
• 109 Thiranagama R. Nerve supply of the human vastus medialis muscle. J Anat 1990; 170: 193-198
• 110 Goh JC, Lee PY, Bose K. A cadaver study of the function of the oblique part of vastus medialis. J Bone Joint Surg Br 1995; 77 (2) 225-231
• 111 Bull AMJ, Senavongse WW, Taylor AR , et al. The effect of the oblique portions of the vastus medialis and lateralis on patellar tracking. Proceedings of the 11th Conference of the ESB; Toulouse, France; 1998
• 112 Gryzlo SM, Patek RM, Pink M, Perry J. Electromyographic analysis of knee rehabilitation exercises. J Orthop Sports Phys Ther 1994; 20 (1) 36-43
• 113 Smith GP, Howe TE, Oldham JA , et al. Assessing quadriceps muscles recruitment order using rectified averages. Clin Rehabil 1995; 9: 40-46
• 114 Isear Jr JA, Erickson JC, Worrell TW. EMG analysis of lower extremity muscle recruitment patterns during an unloaded squat. Med Sci Sports Exerc 1997; 29 (4) 532-539
• 115 Gilleard W, McConnell J, Parsons D. The effect of patellar taping on the onset of vastus medialis obliquus and vastus lateralis muscle activity in persons with patellofemoral pain. Phys Ther 1998; 78 (1) 25-32
• 116 Cowan SM, Bennell KL, Hodges PW, Crossley KM, McConnell J. Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. Arch Phys Med Rehabil 2001; 82 (2) 183-189
• 117 Cowan SM, Hodges PW, Bennell KL, Crossley KM. Altered vastii recruitment when people with patellofemoral pain syndrome complete a postural task. Arch Phys Med Rehabil 2002; 83 (7) 989-995
• 118 Lewallen DG, Riegger CL, Myers ER, Hayes WC. Effects of retinacular release and tibial tubercle elevation in patellofemoral degenerative joint disease. J Orthop Res 1990; 8 (6) 856-862
• 119 Ho SSW, Jaureguito JW. Functional anatomy and biomechanics of the patellofemoral joint. Oper Tech Sports Med 1994; 2: 243
• 120 Fitzgerald RH, Kaufer H, Malkani AL. Orthopaedics. New York: Elsevier Health Sciences; 2002
• 121 Csintalan RP, Schulz MM, Woo J, McMahon PJ, Lee TQ. Gender differences in patellofemoral joint biomechanics. Clin Orthop Relat Res 2002; (402) 260-269
• 122 Nisell R, Németh G, Ohlsén H. Joint forces in extension of the knee. Analysis of a mechanical model. Acta Orthop Scand 1986; 57 (1) 41-46
• 123 Grelsamer RP, Klein JR. The biomechanics of the patellofemoral joint. J Orthop Sports Phys Ther 1998; 28 (5) 286-298
• 124 Steinkamp LA, Dillingham MF, Markel MD, Hill JA, Kaufman KR. Biomechanical considerations in patellofemoral joint rehabilitation. Am J Sports Med 1993; 21 (3) 438-444
• 125 Zwerver J, Bredeweg SW, Hof AL. Biomechanical analysis of the single-leg decline squat. Br J Sports Med 2007; 41 (4) 264-268 , discussion 268
• 126 Carson Jr WG, James SL, Larson RL, Singer KM, Winternitz WW. Patellofemoral disorders: physical and radiographic evaluation. Part II: Radiographic examination. Clin Orthop Relat Res 1984; (185) 178-186
• 127 Witvrouw E, Lysens R, Bellemans J, Peers K, Vanderstraeten G. Open versus closed kinetic chain exercises for patellofemoral pain. A prospective, randomized study. Am J Sports Med 2000; 28 (5) 687-694
• 128 Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med 2002; 30 (3) 447-456
• 129 Pavlov H, Burke M, Gies M, Seager K. Orthopaedist's Guide to Plain Film Imaging. New York: Thieme Medical Publishers; 1999
• 130 Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 1974; 56 (7) 1391-1396
• 131 Walsh W. Recurrent dislocation of the knee in the adult. In: Delee J, Drez D, eds. Delee and Drez's Orthopaedic Sports Medicine. 2nd ed. Philadelphia: Saunders; 2003: 1710-1749
• 132 White BJ, Sherman OH. Patellofemoral instability. Bull NYU Hosp Jt Dis 2009; 67 (1) 22-29
• 133 Alemparte J, Ekdahl M, Burnier L , et al. Patellofemoral evaluation with radiographs and computed tomography scans in 60 knees of asymptomatic subjects. Arthroscopy 2007; 23 (2) 170-177
• 134 Miller MD. Review of Orthopaedics. 5th ed. New York: Saunders Elsevier; 2008
• 135 Schutzer SF, Ramsby GR, Fulkerson JP. Computed tomographic classification of patellofemoral pain patients. Orthop Clin North Am 1986; 17 (2) 235-248
• 136 Schutzer SF, Ramsby GR, Fulkerson JP. The evaluation of patellofemoral pain using computerized tomography. A preliminary study. Clin Orthop Relat Res 1986; (204) 286-293
• 137 Haas SB, Scuderi GR. Examination and radiographic assessment of the femoropatellar joint. Semin Orthod 1990; 5: 1-11
• 138 Stanford W, Phelan J, Kathol MH , et al. Patellofemoral joint motion: evaluation by ultrafast computed tomography. Skeletal Radiol 1988; 17 (7) 487-492
• 139 Muhle C, Brossmann J, Heller M. Kinematic CT and MR imaging of the patellofemoral joint. Eur Radiol 1999; 9 (3) 508-518
• 140 Nakanishi K, Inoue M, Harada K , et al. Subluxation of the patella: evaluation of patellar articular cartilage with MR imaging. Br J Radiol 1992; 65 (776) 662-667
• 141 Quinn SF, Rose PM, Brown TR, Demlow TA. MR imaging of the patellofemoral compartment. Magn Reson Imaging Clin N Am 1994; 2 (3) 425-440
• 142 Recht MP, Resnick D. MR imaging of articular cartilage: current status and future directions. AJR Am J Roentgenol 1994; 163 (2) 283-290
• 143 Linklater J, Potter HG. Imaging of chondral defects. Oper Tech Orthop 1997; 7: 279-288
• 144 Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am 1998; 80 (9) 1276-1284
• 145 Gold GE, Chen CA, Koo S, Hargreaves BA, Bangerter NK. Recent advances in MRI of articular cartilage. AJR Am J Roentgenol 2009; 193 (3) 628-638
• 146 Wang YX, Griffith JF, Ahuja AT. Non-invasive MRI assessment of the articular cartilage in clinical studies and experimental settings. World J Radiol 2010; 2 (1) 44-54
• 147 Crema MD, Roemer FW, Marra MD , et al. Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research. Radiographics 2011; 31 (1) 37-61
• 148 Stoller DW. Magnetic Resonance Imaging in Orthopaedic and Sports Medicine. Philadelphia: Walters Kluwert Lippincott Williams & Wilkins; 2007
• 149 Vallotton JA, Meuli RA, Leyvraz PF, Landry M. Comparison between magnetic resonance imaging and arthroscopy in the diagnosis of patellar cartilage lesions: a prospective study. Knee Surg Sports Traumatol Arthrosc 1995; 3 (3) 157-162
• 150 Link TM, Stahl R, Woertler K. Cartilage imaging: motivation, techniques, current and future significance. Eur Radiol 2007; 17 (5) 1135-1146
• 151 Dejour H, Walch G, Neyret P, Adeleine P. [Dysplasia of the femoral trochlea]. Rev Chir Orthop Repar Appar Mot 1990; 76 (1) 45-54
• 152 Dejour D, Locatelli E. Patellar Instability in Adults: Surgical Techniques. Orthopedics and Traumatology. Paris: Editions Scientifiques et Medicales Elsevier; 2001
• 153 Diks MJ, Wymenga AB, Anderson PG. Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella. Knee Surg Sports Traumatol Arthrosc 2003; 11 (6) 384-388
• 154 Bereiter H, Gautier EA. Die trochleaplastic als chirurgische Therapie der rezidivierenden Patellaluxation bei Trochleadysplasie des Femurs. Arthroskopie 1994; 7: 281-286
• 155 Schöttle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J. Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 2005; 76 (5) 693-698
• 156 Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971; 101 (1) 101-104
• 157 Insall J, Goldberg V, Salvati E. Recurrent dislocation and the high-riding patella. Clin Orthop Relat Res 1972; 88: 67-69
• 158 Kannus PA. Long patellar tendon: radiographic sign of patellofemoral pain syndrome—a prospective study. Radiology 1992; 185 (3) 859-863
• 159 Geenen E, Molenaers G, Martens M. Patella alta in patellofemoral instability. Acta Orthop Belg 1989; 55 (3) 387-393
• 160 Neyret P, Robinson AH, Le Coultre B, Lapra C, Chambat P. Patellar tendon length—the factor in patellar instability?. Knee 2002; 9 (1) 3-6
• 161 Kujala UM, Osterman K, Kvist M, Aalto T, Friberg O. Factors predisposing to patellar chondropathy and patellar apicitis in athletes. Int Orthop 1986; 10 (3) 195-200
• 162 Møller BN, Krebs B, Jurik AG. Patellofemoral incongruence in chondromalacia and instability of the patella. Acta Orthop Scand 1986; 57 (3) 232-234
• 163 Grelsamer RP, Meadows S. The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res 1992; (282) 170-176
• 164 Schlenzka D, Schwesinger G. The height of the patella: an anatomical study. Eur J Radiol 1990; 11 (1) 19-21
• 165 Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br 1977; 59 (2) 241-242
• 166 Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. [Patella infera. Apropos of 128 cases]. Rev Chir Orthop Repar Apparatrice Mot 1982; 68 (5) 317-325
• 167 de Carvalho A, Holst Andersen A, Topp S, Jurik AG. A method for assessing the height of the patella. Int Orthop 1985; 9 (3) 195-197
• 168 Miller TT, Staron RB, Feldman F. Patellar height on sagittal MR imaging of the knee. AJR Am J Roentgenol 1996; 167 (2) 339-341
• 169 Shabshin N, Schweitzer ME, Morrison WB, Parker L. MRI criteria for patella alta and baja. Skeletal Radiol 2004; 33 (8) 445-450
• 170 Flören M, Davis J, Peterson MG, Laskin RS. A mini-midvastus capsular approach with patellar displacement decreases the prevalence of patella baja. J Arthroplasty 2007; 22 (6, Suppl 2) 51-57
• 171 Dandy DJ, Desai SS. The results of arthroscopic lateral release of the extensor mechanism for recurrent dislocation of the patella after 8 years. Arthroscopy 1994; 10 (5) 540-545
• 172 Shaffer BS, Tibone JE. Patellar tendon length change after anterior cruciate ligament reconstruction using the midthird patellar tendon. Am J Sports Med 1993; 21 (3) 449-454
• 173 Hockings M, Cameron JC. Patella baja following chronic quadriceps tendon rupture. Knee 2004; 11 (2) 95-97
• 174 Tria Jr AJ, Alicea JA, Cody RP. Patella baja in anterior cruciate ligament reconstruction of the knee. Clin Orthop Relat Res 1994; (299) 229-234
• 175 Mariani PP, Del Signore S, Perugia L. Early development of patella infera after knee fractures. Knee Surg Sports Traumatol Arthrosc 1994; 2 (3) 166-169
• 176 Closkey RF, Windsor RE. Alterations in the patella after a high tibial or distal femoral osteotomy. Clin Orthop Relat Res 2001; (389) 51-56
• 177 Kesmezacar H, Erginer R, Ogut T, Seyahi A, Babacan M, Tenekecioglu Y. Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2005; 13 (7) 539-544
• 178 Okamoto R, Koshino T, Morii T. Shortening of patellar ligament and patella baja with improvement of quadriceps muscle strength after high tibial osteotomy. Bull Hosp Jt Dis 1993; 53 (3) 21-24
• 179 Scuderi GR, Windsor RE, Insall JN. Observations on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am 1989; 71 (2) 245-248
• 180 Cameron HU, Jung YB. Patella baja complicating total knee arthroplasty. A report of two cases. J Arthroplasty 1988; 3 (2) 177-180
• 181 Chonko DJ, Lombardi Jr AV, Berend KR. Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 2004; 12: 231-238
• 182 Grelsamer RP. Patella baja after total knee arthroplasty: is it really patella baja?. J Arthroplasty 2002; 17 (1) 66-69
• 183 Koshino T, Ejima M, Okamoto R, Morii T. Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis. J Arthroplasty 1990; 5 (4) 323-327
• 184 Minkowitz RB, Bosco III JA. Patellofemoral arthritis. Bull NYU Hosp Jt Dis 2009; 67 (1) 30-38
• 185 Minas T, Bryant T. The role of autologous chondrocyte implantation in the patellofemoral joint. Clin Orthop Relat Res 2005; (436) 30-39
• 186 Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM. The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res 2002; (402) 206-212
• 187 McAlindon TE, Snow S, Cooper C, Dieppe PA. Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis 1992; 51 (7) 844-849
• 188 Leadbetter WB, Ragland PS, Mont MA. The appropriate use of patellofemoral arthroplasty: an analysis of reported indications, contraindications, and failures. Clin Orthop Relat Res 2005; (436) 91-99
• 189 Lonner JH. Patellofemoral arthroplasty: pros, cons, and design considerations. Clin Orthop Relat Res 2004; (428) 158-165
• 190 Lonner JH. Patellofemoral arthroplasty. In: Lotke PA, Lonner JH, eds. Master Techniques in Orthopaedic Surgery: Knee Arthroplasty. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2003: 261-273
• 191 Parvizi J, Klatt B. Essentials in Total Knee Arthroplasty. Thorofare, NJ: SLACK Incorporated; 2011