Patella

Structure

The patella is a sesamoid bone roughly triangular in shape, with the apex of the patella facing downwards. The apex is the most inferior (lowest) part of the patella. It is pointed in shape, and gives attachment to the patellar ligament.

The front and back surfaces are joined by a thin margin and towards centre by a thicker margin. The tendon of the quadriceps femoris muscle attaches to the base of the patella., with the vastus intermedius muscle attaching to the base itself, and the vastus lateralis and vastus medialis are attached to outer lateral and medial borders of patella respectively.

The upper third of the front of the patella is coarse, flattened, and rough, and serves for the attachment of the tendon of the quadriceps and often has exostoses. The middle third has numerous vascular canaliculi. The lower third culminates in the apex which serves as the origin of the patellar ligament. The posterior surface is divided into two parts.

The upper three-quarters of the patella articulates with the femur and is subdivided into a medial and a lateral facet by a vertical ledge which varies in shape.

In the adult the articular surface is about 12 cm² (1.9 sq in) and covered by cartilage, which can reach a maximal thickness of 6 mm (0.24 in) in the centre at about 30 years of age. Due to the great stress on the patellofemoral joint during resisted knee flexion, the articular cartilage of the patella is among the thickest in the human body.

The lower part of the posterior surface has vascular canaliculi filled and is filled by fatty tissue, the infrapatellar fat pad.

Variation

Emarginations (i.e. patella emarginata, a "missing piece") are common laterally on the proximal edge. Bipartite patellas are the result of an ossification of a second cartilaginous layer at the location of an emargination. Previously, bipartite patellas were explained as the failure of several ossification centres to fuse, but this idea has been rejected. Partite patellas occur almost exclusively in men. Tripartite and even multipartite patellas occur.

The upper three-quarters of the patella articulates with the femur and is subdivided into a medial and a lateral facet by a vertical ledge which varies in shape. Four main types of articular surface can be distinguished:

1. Most commonly the medial articular surface is smaller than the lateral.
2. Sometimes both articular surfaces are virtually equal in size.
3. Occasionally, the medial surface is hypoplastic or
4. the central ledge is only indicated.

Development

In the patella an ossification centre develops between the ages 3–6 years. The patella originates from two centres of ossification which unite when fully formed.

Function

The primary functional role of the patella is knee extension. The patella increases the leverage that the tendon can exert on the femur by increasing the angle at which it acts.

It is attached to the tendon of the quadriceps femoris muscle, which contracts to extend/straighten the knee. The patella is stabilized by the insertion of the horizontal fibres of vastus medialis and by the prominence of the lateral femoral condyle, which discourages lateral dislocation during flexion. The retinacular fibres of the patella also stabilize it during exercise.

Patella allows uniaxial movements of legs that is back and straightning movements in 180 degree angle

Dislocation

Patellar dislocations occur with significant regularity, particular in young female athletes. It involves the patella sliding out of its position on the knee, most often laterally, and may be associated with extremely intense pain and swelling. The patella can be tracked back into the groove with an extension of the leg, and therefore sometimes returns into the proper position on its own.

Fracture

The kneecap is prone to injury because of its particularly exposed location, and fractures of the patella commonly occur as a consequence of direct trauma onto the knee. These fractures usually cause swelling and pain in the region, bleeding into the joint (hemarthrosis), and an inability to extend the knee. Patella fractures are usually treated with surgery, unless the damage is minimum and the extensor mechanism is intact.

Exostosis

An exostosis is the formation of new bone onto a bone, as a result of excess calcium formation. This can be the cause of chronic pain when formed on the patella.

Other animals

The patella has convergently evolved in placental mammals and birds; most marsupials have only rudimentary, non-ossified patellae although a few species possess a bony patella. A patella is also present in the living monotremes, the platypus and the echidna. In more primitive tetrapods, including living amphibians and most reptiles (except some Lepidosaurs), the muscle tendons from the upper leg are attached directly to the tibia, and a patella is not present.

Etymological history

The etymology of patella presents a case of convergent etymology. In the Western world, 'patella' originated in the late 17th century from the diminutive form of Latin patina or patena or paten, meaning shallow dish. The use of this term in Eastern medicine, however, predates the Western etymology. As early as the 13th century, traditional Ayurveda practitioners in the Indian subcontinent referred to the kneecap as paṭēla haḍḍī (Hindi: पटेल हड्डी), literally 'farmer's bone' because the grueling life of a patidar. The term was subsequently shortened to just 'patela'. During the British Raj period, Western medicine was introduced to India, and the two etymologies converged into the modern medical use, with two 'L's.