Arthroskopie

, Volume 18, Issue 4, pp 282–288 | Cite as

Ossäre und chondrale Anatomie des patellofemoralen Gelenks

Leitthema
  • 122 Downloads

Zusammenfassung

Chronische Schmerzen im vorderen Kniegelenkbereich sowie Instabilitäten des patellofemoralen Gelenks sind im klinischen Alltag häufig beobachtete Probleme. Morphologische Besonderheiten wie eine Dysplasie der Trochlea femoris oder Form- und Positionsabweichungen der Kniescheibe beeinträchtigen dabei die Funktion des patellofemoralen Gelenks als integralen Bestandteil des Kniegelenks.

Die Patella bildet in ihrer Funktion als Sesambein einerseits einen wichtigen Hebelarm für die Kraftübertragung der Quadrizepsmuskulatur bei der Streckung im Kniegelenk, andererseits muss das Gelenk zwischen Trochlea und Patella großen Druck- und Zugkräften widerstehen.

In dieser Arbeit versuchen wir sowohl einen Überblick über die knöcherne Anatomie des Patellofemoralgelenks zu geben als auch unter Berücksichtigung des Knorpelaufbaus die Eigenschaften des patellofemoralen Gleitlagers zu erläutern.

Schlüsselwörter

Patellofemorales Gelenk Anatomie Funktion 

Bony and chondral anatomy of the patellofemoral joint

Abstract

Chronic anterior knee pain due to arthritic changes of the patellofemoral joint as well as instability of the patella are well-known problems for the clinician. Pathologic changes of the patellofemoral joint such as trochlear dysplasia or abnormality in form and position of the patella can cause severe impairment of knee joint function.

The patella as the largest sesamoid bone of our body serves as a biomechanical lever arm of the quadriceps muscle. However, the joint between the patella and its counterpart, the trochlea, also has to withstand large tension forces as well as compression forces as an integral part of the knee joint.

A good knowledge base of bony anatomy and chondral morphology — influencing patellar tracking during knee flexion as well as patellar stability — is necessary for successful treatment of patellofemoral problems.

Keywords

Patellofemoral joint Anatomy Function 
This is a preview of subscription content, log in to check access.

Notes

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Literatur

  1. 1.
    Aglietti P, Insall J, Cerulli P (1983) Patellar pain and incongruence. I. Measurements of incongruence. Clin Orthop 176:217–224Google Scholar
  2. 2.
    Aglietti P, Buzzi R, Insall J (1993) Disorders of the patellofemoral joint. In: Insall JN (ed) Surgery of the knee. Churchill Livingstone, New York, pp 246–251Google Scholar
  3. 3.
    Baumgartl F (1964) Das Kniegelenk. Springer, Berlin Heidelberg New YorkGoogle Scholar
  4. 4.
    Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg 59-B:241Google Scholar
  5. 5.
    Caton J, Deschamps G, Chambat P, Lerat JL, Déjour H (1982) Les rotules basses — a propos de 128 observations. Rev Chir Orthop 68:317Google Scholar
  6. 6.
    Chew JT, Stewart NJ, Hanssen AD et al. (1997) Differences in patellar tracking and knee kinematics among three different total knee designs. Clin Orthop 345:87–89Google Scholar
  7. 7.
    Cicuttini FM, Wang YY, Forbes A, Wluka AE, Glisson M (2003) Comparison between patella cartilage volume and radiological assessment of the patellofemoral joint. Clin Exp Rheumatol 21:321–326Google Scholar
  8. 8.
    De Carvalho A, Andersen AH, Topp S, Jurik AG (1985) A method for assessing the height of the patella. Int Orthop 9:195Google Scholar
  9. 9.
    Dejour D, Locatelli E (2001) Patellar instability in adults: surgical techniques. In: Orthopedics and traumatology. Elsevier, Paris, pp 55–520Google Scholar
  10. 10.
    Dejour H, Walch G, Neyret P, Adeleine P (1990) La dysplasie de la trochlée fémorale. Rev Chir Orthop 76:45–54Google Scholar
  11. 11.
    Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability : an anatomic radiographic study. Knee Surg Sports Traumatol Arthros 2:19–26Google Scholar
  12. 12.
    Dejour D, Levigne C, Dejour H (1995) La rotule basse post-opératoire. Traitement par allongement du tendon rotulien. Rev Chir Orthop Rép Appar Mot 81:286–295Google Scholar
  13. 13.
    Dejour D, Reynaud P, Lecoultre B (1998) Douleurs et instabilité rotulienne, essai de classification. Méd Hyg 56:1466–1471Google Scholar
  14. 14.
    Dye SF (1993) Patellofemoral anatomy. In: Fox JM, Del Pizzo W (eds) The Patellofemoral joint. Mc Graw Hill, Maidenhead, pp 1–11Google Scholar
  15. 15.
    Fulkerson JP, Hungerford DS (1990) Biomechanics of the patellofemoral joint. In: Fulkerson JP (1990) Disorders of the patellofemoral joint. Williams & Wilkins, Baltimore, pp 25–41Google Scholar
  16. 16.
    Godefroy D, Tavernier T (2004) Imagerie de l’arthrose fémoro-patellaire isolée. Rev Chir Orthop 90 [suppl]:S75–77Google Scholar
  17. 17.
    Goodfellow J, Hungerford DS, Zindel M (1976) Patellofemoral joint mechanics and pathology. J Bone Joint Surg 58B:287–290Google Scholar
  18. 18.
    Grelsamer RP, Meadows S (1992) The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop 282:170–176Google Scholar
  19. 19.
    Heegard J, Leyvraz PF, Curnier A et al. (1995) The biomechanics of the human patella during passive knee flexion. J Biomech 28:1265–1279Google Scholar
  20. 20.
    Heegard J, Leyvraz PF, Kampen AV et al. (1994) Influence of soft structures on patellar three-dimensional tracking. Clin Orthop 299:235–243Google Scholar
  21. 21.
    Hungerford DS, Barry N (1979) Biomechanics of the patellofemoral joint. Clin Orthop 144:9–15Google Scholar
  22. 22.
    Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104PubMedGoogle Scholar
  23. 23.
    Insall J, Goldberg V, Salvati E (1972) Recurrent dislocation and the high-riding patella. Clin Orthop 88:67–69Google Scholar
  24. 24.
    Kampen AV, Huiskes R (1990) The three-dimensional tracking pattern of the human patella. J Orthop Res 8:372–382PubMedGoogle Scholar
  25. 25.
    Lancourt JE, Cristini JA (1975) Patella alta and patella infera. J Bone Joint Surg 57:1112–1115Google Scholar
  26. 26.
    Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg [Am] 56(7):1391–1396Google Scholar
  27. 27.
    Moro-oka T, Matsuda S, Miura H, Nagamine R, Urabe K, Kawano T, Higaki H, Iwamoto Y (2002) Patellar tracking and patellofemoral geometry in deep knee flexion. Clin Orthop 394:161–168Google Scholar
  28. 28.
    Romero J, Borgeat A, Cartier P (1999) Patella baja. Arthroskopie 12:237–245Google Scholar
  29. 29.
    Schlenzka D, Schwesinger G (1990) The height of the patella: an anatomical study. Eur J Radiol 11:19–21Google Scholar
  30. 30.
    Stäubli HU, Durenmatt U, Porcellini B, Rauschning W (1999) Anatomy and surface geometry of the patellofemoral joint in the axial plane. J Bone J Surg 81(3):452–458Google Scholar
  31. 31.
    Stäubli HU, Bosshard C, Porellini P, Rauschning W (2002) Magnetic resonance imaging for articular cartilage: cartilage-bone mismatch. Clin Sports Med 21:417–433Google Scholar
  32. 32.
    Tavernier T, Dejour D (2001) Imagerie du genou: quel examen choisir? J Radiol 82:387–405; 407–408Google Scholar
  33. 33.
    Tria AJ jr, Alicea JA (1995) Embryology and anatomy of the patella. In: Scuderi GR (ed) The patella. Springer, Berlin Heidelberg New York, pp 11–23Google Scholar
  34. 34.
    Wiberg G (1941) Roentgenographic and anatomic studies on the femoro-patellar joint. Acta Orthop Scand 12:319–410Google Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Klinik für Unfallchirurgie und SporttraumatologieMedizinische Universität Innsbruck
  2. 2.Corolyon Clinic Sauvegarde, Frankreich
  3. 3.Klinik für Unfallchirurgie und SporttraumatologieMedizinische UniversitätInnsbruck

Personalised recommendations