Patellar Medial

Van Hoogmoed LM, Agnew DW, Whitcomb M, et al. Ultrasonographic and histologic evaluation of medial and middle patellar ligaments in exercised horses following injection with ethanola-mine oleate and 2% iodine in almond oil. Am ] Vet Res 2002 63(5) 738-743. 

The patellofemoral contact area is smaller than the tibiofemoral contact area (Table 49.10). As the knee joint moves from extension to flexion, a band of contact moves upward over the patellar surface (Figure 49.10). As knee flexion increases, not only does the contact area move superiorly, but it also becomes larger. At 90° of knee flexion, the contact area has reached the upper level of the patella. As the knee continues to flex, the contact area is divided into separate medial and lateral zones. 

F1GURE49.8 Medial (ym) andlateral (/n) patellar facet angles. (FromAhmedA.M.,BurkeD.L., andHyderA. 1987. 

FIGURE 6.6 Force versus length curves for human medial patellar tendon, gracilis tendon, fascia lata tendon, and the anterior cruciate ligament. 

The PTB socket design, initially developed at the University of California at Berkeley in the late 1950s, accommodates the nonuniform load-bearing tolerances of the residual limb. The basic concept of the PTB socket is to distribute the load over areas of the residual limb in proportion to their ability to tolerate load. Therefore, the majority of the load is to be borne on the patellar tendon (hence the name), medial and lateral flares of the tibia, and the popliteal area. The PTB socket precompresses the residual limb tissues in these load areas so that forces are transmitted comfortably and movement of the socket relative to the skeleton is minimized.The socket is thus a replica of the residual... 

Patellar tendons from donors ranging in age from 17 to 54 years were tested at either 10% or 100% elongation per second, to examine effects of donor and strain rate on tensile properties. A pressure micrometer was used to measure cross-sectional area and the initial length of the tendon (from patellar to tibial insertion site) was used for strain measurements. Specimens were kept moist with a saline spray during tensile testing. Medial, lateral, and sometimes central portions were taken from 25 donors regional differences across the tendon were not considered. 

Papageorgiou CD, Kostopoulos VK, Moebius UG, Petropoulou KA, Georgoulis AD, Soucacos PN (2(X)1) Patellar ftactures associated with medial-third bone-patellar tendon-bone autograft ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 9 151-154... 

Fig. 15.1 Locations of the three portals and landmarks on the right knee joint for ACL reconstruction using the far anteromedial portal technique. AL anterolateral portal, AM anteromedial portal, FAM far anteromedial portal, FT patellar tendon, IFF inferior pole of the patella, UL lateral joint line, MJL medial joint line, 7T tibial tuberosity...

With visualization from the anterolateral (AL) portal, insert a 23-gauge spinal needle from just medial to the medial border of the patellar tendon and about 1 cm above the joint line. Insert the 23-gauge spinal needle into the knee joint toward the intercondylar notch while visualizing the direction of the needle using a... 

The optimum location for the FAM portal during ACL reconstruction should avoid cartilage damage to the medial femoral condyle. This portal is usually created just above the medial meniscus and approximately 2.5 cm medial to the medial border of the patellar tendon. Using preoperative three-dimensional computed... 

The optimum FAM portal position was previously studied using preoperative 3D CT [14]. Based rai the results of that study, the optimum location for the FAM portal was less than 30 mm from the medial border of the patellar tendon in male patients and less than 25 nun in female patients. Furthermore, in female patients less than 160 cm tall, it should be placed 20 mm from the medial border of the patellar tendon. This optimum location for the FAM portal during ACL reconstruction using the FAM portal technique should be used to avoid damaging the medial femoral condyle cartilage (Fig. 15.3a, b). 

Linder LH, Sukin DL, Burks RT et al (1994) Biomechanical and histological properties of the canine patellar tendon after removal of its medial third. Am J Sports Med 22(1) 136-142... 

The graft is harvested through 5-6-cm longitudinal skin incision just medial to the patellar tendon from the central portion of the medial half of the patellar tendon. As the central portion of the tendon is shorter than the lateral or medial side, the graft has longer and shorter side in its tendinous portion. The former is assigned to anteromedial portion of the graft, and the shorter one is to the posterolateral portion (Fig. 30.3). 

Fig. 30.3 Graft harvest and preparation, (a) BTB graft harvest site of the central portion of the medial half of the patellar tendon of the right knee. The tendinous portion of the graft has longer and shorter sides, (b) Prepared graft of lO-mm in width of the right knee. The parallelepiped bone plug from the tibia of 5 mm thick x 10 mm wide x 15 mm long is for the rectangular femoral tunnel, while patellar bone block of a triangular pillar is for the distal round portion of the tibial tunnel...

Arthroscopic view (c) and medial view of a postoperative three-dimensional (3D) computed tomography (CT) reconstruction (d) of an anatomically created rectangular femmal tunnel (white arrow) for a bone-patellar tendon-bone (BPTB) graft overlapped with a proximal bone defect (white triangles). 

In a study of diabetic Pima Indians, Nelson et al. (7) identified risk factors associated with a high probability for limb amputation among diabetic individuals. These included presence of diabetic retinopathy, nephropathy, hypertension, absent patellar tendon reflexes, and presence of medial arterial calciflcation. However, no single risk factorwas identified as being relatively more important than another. 

The femoropatellar joint is a sellar joint the articulating surface of the patella is adapted to the patellar surface of the femur. This femoral articulation involves the anterior surface of both condyles. An oblique groove divides it into a large lateral and smaller medial area. The quadriceps muscles, the quadriceps tendon, and the patellar tendon maintain the joint s stability. Its major motions are vertical up-and-down movement on the femur, and movement in a sagittal plane with respect to the tibia. This allows a pulley function during flexion and extension of the knee. 

FIG. 98-5 Location of the tender points around the knee. PAT, patellar LM, lateral meniscus LH, lateral hamstring MM, medial meniscus MH, medial hamstring EX, gastrocnemius AC, anterior cruciate PC, posterior cruciate. 

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