Anatomy (Patellofemoral Joint)

ANATOMY (PATELLOFEMORAL JOINT)
According to (Magee, 2014), the patellofemoral joint is a modified plane joint, and the patella 's lateral articular
surface is wider. The patella comprises the body's thickest cartilage layer which is a sesamoid bone located inside the
patellar tendon. It has five facets or ridges: superior, inferior, lateral, medial, and odd. In chondromalacia patellae (i.e. early
degeneration of the patellar cartilage) or patellofemoral syndrome, it is the odd facet that is most commonly the first portion
of the patella that is affected.
(Area of contact of the patella during varying degrees of flexion)
Range of flexion of the knee Facet in contact

0° (knee extension) NO contact
15-20° Inferior pole
45° Middle pole
90° All facets (Maximum contact)
135° (full flexion Odd facet & lateral facet of posterior patella
Various portions of the patella articulate with the femoral condyles during the movement from flexion to extension.
Only when 135° flexion is achieved, the odd facet does not come into contact with the femoral condyles. Patellofemoral
arthralgia may be caused by improper orientation or malalignment of patellar movement over the femoral condyles. This
joint capsule is continuous with the tibiofemoral joint capsule.
At the last 30° of extension (i.e., 30° to 0° of extension with the straight leg being 0°), the patella increases the
quality of extension since it holds the quadriceps tendon away from the movement axis. The patella also serves as a
reference for the quadriceps or patellar tendon, reduces friction of the quadriceps mechanism, controls knee capsular
tension, serves as a bony shield for the femoral condyle cartilage, and enhances the anatomical appearance of the knee.
(The circles illustrated on the patella demonstrate the point of full contact between the femur and the patella. The
contact point on the patella migrates from the superior to the inferior pole when the knee is extended.)
According to (Houglum & Bertoti, 2012), the patella is connected and located inside the common quadriceps
tendon, which runs over and on the sides of the patella. The patellar ligament is the extension of the quadriceps tendon
from the apex of the patella which extends to the tubercle of the tibia. Tendinous fibers spread out on the sides of the
patella to form the medial and lateral retinacula, which connects to the condyles of the tibia.
When the knee is fully extended, the stability of the patella depends largely on the soft tissues that surround it. The
mechanism of the extensor, or quadriceps, actively stabilizes the patella on all sides and facilitates the movement between
the femur and the patella. The primary function of the vastus medialis oblique (VMO) muscle is to act as a dynamic patella
stabilizer from 20° to 0°.
The patella is passively stabilized laterally by superficial and deep retinacula, the iliotibial band and the vastus
lateralis muscle. These lateral forces are actively balanced by the VMO and passively by the patellofemoral ligament forces
and the medial meniscopatellar ligament on the medial aspect of the patella. In addition, superior stability actively occurs
from the rectus femoris and vastus intermedius attachments to the base of the patella, while the patellar ligament provides
the patella with inferior stability.
The patella lies in the proximal aspect of the intercondylar groove when the tibiofemoral joint is in full extension. The
health and condition of the soft tissues is essential for the alignment of the patella, since the surrounding soft tissues holds it
in position. Patellar orientation is affected by both inert (connective tissue) and active tissue (muscle). Therefore, if inert
structures are tight or muscles are weak or tight, these dysfunctions affect the position of the patella either during rest or
activity; such imbalances can result in injury to the joint of the patellofemoral.
The patella lies in the proximal intercondylar groove with the knee relaxed in maximum extension. The patella
moves in several directions as the knee flexes and extends: flexion-extension, medial-lateral tilt, medial-lateral shift, and
medial-lateral rotation. In all movements, the greatest excursion takes place in flexion and extension as it moves in the
intercondylar groove proximally and distally; the patella travels a distance of 5 to 7 cm from full knee extension to full flexion.
When the knee is fully extended, the apex of the patella lies near the tibiofemoral joint margin. It is a patella baja if
the patella lies more distally on the femur; it is a patella alta if it lies more proximally. In general, the congruence of the joint
surfaces, the elevated lateral trochlear facet and the medial soft tissue stabilizers prevent excessive lateral displacement of
the patella as it tracks on the trochlear surfaces. Imbalances such as iliotibial band tightness or VMO weakness cause the
patella to track more laterally with quadriceps muscle contraction during the movement of the knee and may lead to
changes in the areas of joint contact and pressure with pain and dysfunction usually results.

Anatomy (Patellofemoral Joint)

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ANATOMY (PATELLOFEMORAL JOINT)

(Area of contact of the patella during varying degrees of flexion)

Range of flexion of the knee Facet in contact

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