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Biz C, Stecco C, Crimì A, Pirri C, Fosser M, Fede C, Fan C, Ruggieri P, De Caro R. Are Patellofemoral Ligaments and Retinacula Distinct Structures of the Knee Joint? An Anatomic, Histological and Magnetic Resonance Imaging Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031110. [PMID: 35162134 PMCID: PMC8834464 DOI: 10.3390/ijerph19031110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022]
Abstract
There is disagreement regarding the description of the patellofemoral ligaments (PFLs), considered by some authors as capsular thickening and by others as independent ligaments. It was hypothesised that the PFLs and retinacula are structures with different histological features. The aim of this study was to describe the stabilising structures of the patella in detail and to determine if the PFLs and retinacula are different and separable structures from a macroscopic, microscopic and imaging viewpoint. An anatomical study was performed on eight knees from five cadavers (mean age, 56.2 years; range, 35–63 years), and a histological study was conducted on specimens from nine patients having a mean age of 65 years (range 35–84 years) who had undergone surgical knee procedures. The imaging study was based on 100 MRIs (96 patients). The mean age was 46 years (range 16–88), and the study analysed the capsular-ligamentous structures. In the medial compartment, the layers and structures were as follows: superficial layer, medial retinaculum; intermediate layer, Medial Collateral Ligament (MCL), Posterior Oblique Ligament (POL) and Medial Patellofemoral Ligament (MPFL); deep layer, deep part of the MCL and joint capsule. In the lateral compartment, the layers and structures were the following: superficial layer, lateral retinaculum; intermediate layer, Lateral Collateral Ligament (LCL) and Lateral Patellofemoral Ligament (LPFL); deep layer, joint capsule. All of the knees examined presented a clearly distinguishable MPFL and LPFL separable from the capsular layer. Histological study: there was a higher density of nerve fibres in retinacula compared to ligaments (p = 0.0034) and a higher content of elastic fibres in retinacula (p < 0.0005). In imaging, there was no difference between medial and lateral retinaculum thickness (p > 0.05). In conclusion, both the lateral and medial compartment can be described using the three-layer scheme. PFLs and retinacula are separate structures both macroscopically and according to imaging analysis. The retinacula respond to their specific function with a higher nerve fibre content and higher number of elastic fibres compared to the ligaments.
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Affiliation(s)
- Carlo Biz
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (A.C.); (M.F.); (P.R.)
- Correspondence: ; Tel.: +39-049-8213239
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (C.S.); (C.P.); (C.F.); (C.F.); (R.D.C.)
| | - Alberto Crimì
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (A.C.); (M.F.); (P.R.)
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (C.S.); (C.P.); (C.F.); (C.F.); (R.D.C.)
| | - Michele Fosser
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (A.C.); (M.F.); (P.R.)
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (C.S.); (C.P.); (C.F.); (C.F.); (R.D.C.)
| | - Chenglei Fan
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (C.S.); (C.P.); (C.F.); (C.F.); (R.D.C.)
| | - Pietro Ruggieri
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (A.C.); (M.F.); (P.R.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (C.S.); (C.P.); (C.F.); (C.F.); (R.D.C.)
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Damgacı L, Özer H, Duran S. Patella-patellar tendon angle and lateral patella-tilt angle decrease patients with chondromalacia patella. Knee Surg Sports Traumatol Arthrosc 2020; 28:2715-2721. [PMID: 32451620 DOI: 10.1007/s00167-020-06065-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/14/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the effect of patellofemoral joint morphology and patellar alignment (lateral patellar tilt and sagittal patellar tilt) on the presence and stage of CP, and identify the differences between sexes. METHODS MRI of 243 patients [146 men (60.1%)] were evaluated retrospectively. Patients were grouped as normal group without chondromalacia, group with mild chondromalacia (grades 1-2) and group with severe chondromalacia (grades 3-4). Sagittal patellofemoral alignment was assessed by the angle between the patella and patellar tendon (P-PTA), and the angle between the quadriceps tendon and patella (Q-PA). Patellar tilt was assessed by lateral patellar tilt angle (LPTA). In addition, patellofemoral joint morphology was evaluated by measuring trochlear depth (TD), trochlear sulcus angle (TSA) and patella angle (PA). RESULTS P-PTA, Q-PA, LPTA and TD values were significantly lower in patients with severe chondromalacia than in patients with both normal and mild chondromalacia (P < 0.001). TSA values were significantly higher in patients with severe chondromalacia than those with both normal and mild chondromalacia (P < 0.001). TSA was higher and TD was lower in women compared to men (P < 0.001). LPTA and P-PTA were lower in women compared to men, and the difference was significant. There was no difference in PA between the two sexes. CONCLUSIONS Patellar cartilage degeneration increases with trochlear dysplasia. There is a strong correlation between patellar malalignment (lateral patellar tilt and sagittal patellar tilt) and chondromalacia patella. Women are more prone to developing CP than men.
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Affiliation(s)
- Lale Damgacı
- Ankara City Hospital, Üniversiteler mh. Bilkent cd. No: 1, 06800, Çankaya/Ankara, Turkey.
| | - Hamza Özer
- Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Zeynep Kamil mh. Dr. Burhanettin Üstünel Sokağı No: 10, 34668, Üsküdar/İstanbul, Turkey
| | - Semra Duran
- Ankara City Hospital, Üniversiteler mh. Bilkent cd. No: 1, 06800, Çankaya/Ankara, Turkey
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Fox MG, Chang EY, Amini B, Bernard SA, Gorbachova T, Ha AS, Iyer RS, Lee KS, Metter DF, Mooar PA, Shah NA, Singer AD, Smith SE, Taljanovic MS, Thiele R, Tynus KM, Kransdorf MJ. ACR Appropriateness Criteria® Chronic Knee Pain. J Am Coll Radiol 2018; 15:S302-S312. [DOI: 10.1016/j.jacr.2018.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
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Cheruvu B, Tsatalis J, Laughlin R, Goswami T. Methods to determine the volume of infrapatellar fat pad as an indicator of anterior cruciate ligament tear. BIOMATERIALS AND BIOMECHANICS IN BIOENGINEERING 2016. [DOI: 10.12989/bme.2016.3.1.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Unusual Symptomatic Multipartite Patella Associated with Quadriceps Fat Pad Edema. J Belg Soc Radiol 2016; 100:49. [PMID: 30151457 PMCID: PMC6102945 DOI: 10.5334/jbr-btr.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Partite patella is a known cause of anterior knee pain, especially in adolescents and young males, although most patients are asymptomatic. Symptomatic partite patella is usually revealed on magnetic resonance imaging (MRI) as bone marrow edema within the opposing bone fragments. We present a case of unusual bilateral symptomatic multipartite patella in an adult who presented with quadriceps fat pad edema and mass effect as well as slightly edematous signal changes within the bone fragments on MRI. This case indicates that symptomatic partite patella can also present with edema-like imaging findings in the adjacent soft tissue due to chronic mechanical irritation.
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Kanamoto T, Tanaka Y, Yonetani Y, Kita K, Amano H, Kusano M, Hirabayashi S, Horibe S. Anterior knee symptoms after double-bundle ACL reconstruction with hamstring tendon autografts: an ultrasonographic and power Doppler investigation. Knee Surg Sports Traumatol Arthrosc 2015; 23:3324-9. [PMID: 24981990 DOI: 10.1007/s00167-014-3142-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 06/12/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Anterior knee pain related to the donor site is a frequent complication of anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone autograft tissue. Even when hamstring tendon (HT) grafts are used instead, symptoms such as mild pain and discomfort can still occur. The purpose of this study was to elucidate the pathophysiology of anterior knee symptoms after ACLR with HT autografts. METHODS Fifty-seven patients (22 men and 35 women; mean age, 24.7 years) who underwent anatomic double-bundle ACLR with HT autografts were examined 6 months post-operatively. The presence of anterior knee symptoms, anterior knee laxity, range of motion, and muscle strength were assessed. Changes in patellar tendon and infrapatellar fat pad (IFP) morphology and blood flow were also evaluated using ultrasound. Potential variables affecting the presence of anterior knee symptoms were subjected to univariate analysis and multivariate logistic regression analysis to identify independent risk factors. RESULTS Six months post-operatively, the total incidence of anterior knee symptoms was 56.1 % (32/57). According to univariate analysis, age, quadriceps strength, and increased blood flow in the IFP were significantly associated with the presence of anterior knee symptoms. Multivariate logistic regression analysis revealed that increased blood flow in the IFP was an independent factor for the presence of anterior knee symptoms (odds ratio 5.0; 95 % confidence interval 1.3-19.9). There were no significant findings inside the patellar tendon. CONCLUSIONS Increased blood flow in the IFP was identified as an independent factor for the presence of anterior knee symptoms 6 months after ACLR with HT autografts. The ultrasound evaluation can help to define precisely the origin of anterior knee symptoms after ACLR with HT autografts. LEVEL OF EVIDENCE Case series with no comparison groups, Level IV.
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Affiliation(s)
- Takashi Kanamoto
- Department of Rehabilitation, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, 597-8025, Japan.
| | - Yoshinari Tanaka
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Yasukazu Yonetani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Keisuke Kita
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Hiroshi Amano
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Masashi Kusano
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Sakai, Japan
| | - Shinji Hirabayashi
- Department of Rehabilitation, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, 597-8025, Japan
| | - Shuji Horibe
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
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Yablon CM, Pai D, Dong Q, Jacobson JA. Magnetic resonance imaging of the extensor mechanism. Magn Reson Imaging Clin N Am 2014; 22:601-20. [PMID: 25442025 DOI: 10.1016/j.mric.2014.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Anterior knee pain is associated with many different causes. The clinical diagnosis may be unclear when the patient initially presents for evaluation. Magnetic resonance (MR) imaging is a valuable modality with high diagnostic accuracy in the evaluation of extensor mechanism pathology, which commonly presents with anterior knee pain. The most common disorders include patellar fracture, patellofemoral tracking abnormalities, tendon trauma and degeneration. These injuries manifest with characteristic patterns on MR imaging. This article discusses normal anatomy, common injuries, and diagnostic pitfalls on MR imaging.
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Affiliation(s)
- Corrie M Yablon
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Deepa Pai
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Qian Dong
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Grando H, Chang EY, Chen KC, Chung CB. MR imaging of extrasynovial inflammation and impingement about the knee. Magn Reson Imaging Clin N Am 2014; 22:725-41. [PMID: 25442030 DOI: 10.1016/j.mric.2014.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The knee has unique anatomy regarding the relationship between the synovial and capsular layers, with interposed fat pads at certain locations. The extrasynovial impingement and inflammation syndromes about the knee are underdiagnosed and should be included in the differential diagnosis of anterior knee pain. MR imaging is the best imaging modality for evaluation of the anatomy and disorders of these extrasynovial compartments.
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Affiliation(s)
- Higor Grando
- Department of Radiology, San Diego Medical Center, University of California, 200 West Arbor Drive, San Diego, CA 92126, USA; Department of Radiology, Hospital do Coração (HCor) and Teleimagem, Desembargador Eliseu Guilherme, 147, Paraíso, São Paulo 04004-030, Brazil.
| | - Eric Y Chang
- Department of Radiology, San Diego Medical Center, University of California, 200 West Arbor Drive, San Diego, CA 92126, USA; Department of Radiology, VA San Diego Healthcare System, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA
| | - Karen C Chen
- Department of Radiology, San Diego Medical Center, University of California, 200 West Arbor Drive, San Diego, CA 92126, USA; Department of Radiology, VA San Diego Healthcare System, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA
| | - Christine B Chung
- Department of Radiology, San Diego Medical Center, University of California, 200 West Arbor Drive, San Diego, CA 92126, USA; Department of Radiology, VA San Diego Healthcare System, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA
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