Patterns of Patellofemoral Articular Cartilage Wear in Cadavers

Abstract

Anatomical studies describe the structure of the articulating bones, the articular cartilage, and the lack of joint congruity. 7,12,17,44,[50][51][52] The triangular patella has a rounded superior pole and a pointed inferior pole (FiGUre 1). Anteriorly, its surface is embedded in the quadriceps tendon. Posteriorly, its surface articulates with t STUdY deSiGn: Descriptive.t oBJeCTiVe: Describe and compare patellar and femoral condylar wear patterns, and the wear frequency of both, relative to each other, gender, and sidedness.t BaCkGroUnd: Studies on normal and pathological patellar cartilage and patellofemoral joint biomechanics are plentiful. However, patellar wear patterns are undefined, as is the relationship of patellar to femoral condylar wear.t MeTHodS: Articular wear was described for 50 patellae and matching femurs from 26 cadavers. Wear locations were transcribed to gridded templates, and these were compared graphically for frequency, gender, and sidedness of wear. The percent frequency of wear was calculated and areas of wear described.t reSULTS: Three patellar and 2 femoral types of wear patterns were observed, and 12 areas of patellar wear and 3 areas of femoral wear described. Patella wear was along the horizontal middle of the patella, with marked medial and odd facet wear. Femoral wear was on the anterior and posterior aspects of the medial condyle, and posterior aspect of the lateral femoral condyle. Patellar and femoral wear frequencies were similar bilaterally, but patellar wear may differ with gender.t ConCLUSionS: Patella and distal femur showed distinct wear patterns. The wear area under the patella matches the contact area between the patella and distal femur normally occurring between 45° to 90° of knee flexion. Patellofemoral assessment and treatment may differ for the aged population because of mechanical changes due to wear.

Retropatellar Cartilage Morphology and Kneeling Ability: Cartilage Wear and Kneeling Function of TKA Patients

“…The gender effect on kneeling ability is an important observation but inconclusive because of a relatively small number of patients involved. According to Gorniak et al the pattern of RPC wears was more central and compact in males than in females (gender difference in wear area) [15]. This gender difference both in wear area noticed by Gorniak et al and the observed kneeling ability differences may also relate to males usually ability before TKA.…”

“…A study performed by Gorniak et al to detect any common specific-joint wear pattern at the patellofemoral joint in 26 cadavers (50 patellae) from older individuals [15]. The study found that there is greater medial patellar facet and odd facet wear than lateral facet wears, suggesting higher medial than lateral patellofemoral joint contact forces.…”

“…The purpose of this research study was to determine whether a high % of RPC wear and the pattern of this wear were related to the kneeling The RPC wear area relates to the area where the medial and lateral patellar facets are in contact with the anterior femoral condyle [15]. In the elderly, activities that require a higher knee flexion are performed with either more difficulty or avoided altogether [15] as a result of decreases in the strength of the knee and hip extensors [16,17].…”

“…In the elderly, activities that require a higher knee flexion are performed with either more difficulty or avoided altogether [15] as a result of decreases in the strength of the knee and hip extensors [16,17].…”

A geometric approach to study the contact mechanisms in the patellofemoral joint of normal versus patellofemoral pain syndrome subjects

“…As such, the main clinical concern has been that patients with PFPS experience a higher load in the lateral facet of the PF joint. But, interestingly, a few recent studies have shown evidence of pain and cartilage wear in the medial side of the PF joints as well as medial shift of the patella (Gorniak 2009;Song et al 2011;Draper et al 2012). These findings have constituted a clear contradiction of the previous reports discussing the PFPS, in which most of the research focused on the lateral aspect (lateral malalignment/ maltracking) of the PF joints as a sole contributor of PFPS.…”