What is the anatomy of the knee relevant to patellofemoral arthritis?

Answer

The patella is a sesamoid bone, the largest in the body, embedded in the quadriceps and patella tendons. A subcutaneous bursa separates the patella from the overlying skin. The articular surface of the patella consists of four facets: inferior, middle, superior, and medial vertical.

During flexion, the patella moves within a groove in the femur, the trochlea. The patella is thought to travel in a J-shaped pattern, moving laterally with knee extension.^[4]

The lateral aspect of the trochlea, the vastus medialis, and the medial patella-femoral ligament prevent excessive lateral translation. The anatomy of the distal femur and the vastus lateralis and lateral patella-femoral ligaments provides restraints against medial subluxation.

The patellar plexus provides the blood supply to the patella. The plexus is an anastomosis of the superior and inferior genicular arteries, which are branches of the popliteal artery,

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Media Gallery

Patellofemoral arthritis. The sulcus angle is the angle formed by the condyles and the sulcus. This is a measurement of trochlear depth. A finding greater than 138° indicates the presence of patellofemoral dysplasia.
Patellofemoral arthritis. The patellofemoral index is the ratio of M, the closest distance between the articular ridge and the medial condyle, and L, the closest distance between the lateral facet and condyle.
Patellofemoral arthritis. The lateral patellofemoral angle is the angle between the intercondylar line and the lateral facet.
Patellofemoral arthritis. The Insall-Salvati ratio is used to assess the position of the patella and determine if the patella alta or patella baja is present. The ratio of the height of the patella to the length of the patella tendon should be 1:1.
Patellofemoral arthritis. Anteroposterior, lateral, and patellar views of an arthritic knee demonstrate severe patellofemoral arthritis. This patient subsequently underwent total knee arthroplasty.
Patellofemoral arthritis. Poor bone quality of the patella made a patella resurfacing procedure impossible in this patient who underwent total knee arthroscopy for severe arthritis.
Patellofemoral arthritis. This patient had severe medial compartment arthritis but a relatively normal patellofemoral joint. Therefore, patellofemoral resurfacing was not performed at the time of surgery.
Patellofemoral arthritis.

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Author

Dinesh Patel, MD, FACS Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Kathleen A Hogan, MD Fellow in Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital

Kathleen A Hogan, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

H Del Schutte, Jr, MD Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Medical University of South Carolina

H Del Schutte, Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, California Medical Association, South Carolina Medical Association, Southern Medical Association, Southern Orthopaedic Association, Orthopaedic Research Society, American Association of Hip and Knee Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Thomas M DeBerardino, MD Orthopedic Surgeon, The San Antonio Orthopaedic Group; Professor of Orthopedic Surgery, Baylor College of Medicine as Co-Director, Combined Baylor College of Medicine-The San Antonio Orthopaedic Group, Texas Sports Medicine Fellowship; Medical Director, Burkhart Research Institute for Orthopaedics (BRIO) of the San Antonio Orthopaedic Group; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Herodicus Society, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; MTF; Aesculap; The Foundry, Cotera; ABMT; Conmed; <br/>Received research grant from: Histogenics; Cotera; Arthrex.

Additional Contributors

Charles T Mehlman, DO, MPH Professor of Pediatrics and Pediatric Orthopedic Surgery, Division of Pediatric Orthopedic Surgery, Director, Musculoskeletal Outcomes Research, Cincinnati Children's Hospital Medical Center

Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association

Disclosure: Nothing to disclose.

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