Intramedullary insertion of the patellar tendon

Abstract

This case represents a rare presentation of an intramedullary insertion of the patellar tendon in an otherwise healthy 8-year-old girl. To our knowledge no such phenomenon has previously been reported in the English literature.

Structure relates to elastic recoil and functional role in quadriceps tendon and patellar ligament

“…However some different morphological aspects and functional responses between suprapatellar and infrapatellar connective tissues have been described: the collagen density is statistically higher in quadriceps tendon compared to patellar ligament (Hadjicostas et al, 2007), and the maximum force in human quadriceps tendon exceeds that in patellar ligament by a ratio of about 8:5 (van Eijden et al, 1987;Harris et al, 1997). Although the anatomy and histology of quadriceps tendon and/or patellar ligament have been described (Evans et al, 1990;Hildebrand et al, 1991;Ralphs et al, 1991Ralphs et al, , 1992Gao et al, 1996;Clark and Stechschulte, 1998;Basso et al, 2001;Lo et al, 2004;Beall et al, 2006;Peace et al, 2006), no morphological studies distinguished the rectus femoris tendon from the vastus intermedius tendon when comparing and relating the suprapatellar and infrapatellar connective tissues to their functional role.…”

The patellar ligament: A comprehensive review

“…In the second case, the PL coursed through an intraosseous tunnel at the anterior tibial cortex, entered the medullary canal, and inserted onto the internal surface of the tibia's posterior wall (Collett et al, 2019). Both cases were surgically corrected by dissecting the distal PL free from its attachment site and re‐attaching it proximally to the tibia, which yielded a normal range of motion for the patients postoperatively (Beall et al, 2006; Collett et al, 2019). An overview of variations of patellar ligament insertion is presented in Table 2.…”

“…The patellar ligament (PL), commonly referred to as the patellar tendon or ligamentum patellae, is the continuation of the quadriceps femoris tendon from the patellar apex to the tibial tuberosity (Beall et al, 2006). This ligament forms part of the extensor mechanism of the lower limb and stabilizes the patella (Beall et al, 2006). The patellar ligament is clinically important due to its correlation to patellar tendinopathy, sometimes called jumper's knee, and its frequent use as an autograft in anterior cruciate ligament (ACL) reconstruction (Basso et al, 2001).…”

“…The patellar ligament (PL), commonly referred to as the patellar tendon or ligamentum patellae, is the continuation of the quadriceps femoris tendon from the patellar apex to the tibial tuberosity (Beall et al, 2006). This ligament forms part of the extensor mechanism of the lower limb and stabilizes the patella (Beall et al, 2006).…”

“…Only a few cases of congenital aplasia of the PL have been reported to date (Çevik & Bulut, 2020; Grissom et al, 1990; Haws et al, 2021; Kasten et al, 2005; Laor et al, 1996; Messina et al, 1997). Variations in PL attachment have caused patellar tendinopathy and significant deformity (Basso et al, 2001; Beall et al, 2006; Collett et al, 2019).…”