Morphometry of the patellar ligament in human fetuses

Öz

Objective: To gather detailed morphometric data of the patellar ligament in human fetuses. Method: Presentstudy is carried out on 32 human fetuses (18 males, 14 females) aged 1832 weeks of gestation with no grosspathology or anomaly. Following the general external measurements of the fetuses each knee region weredissected. The relationships between the patellar ligament and surrounding structures and its localizationwere determined. Morphometric data on length, width, thickness and diameters were gathered. Results:Means and standard deviations of all parameters were calculated for each gestational week. There weresignificant relations between measured parameters and gestational age (p<0.001). There were no sex differencesin parameters (p>0.05). All data were compared with previous studies and discussed. Conclusion: Dataobtained in this study will contribute to other studies carried out in the areas of obstetrics, perinatology,forensic medicine and fetal pathology, aimed at identifying anomalies, pathologies and variations of thepatellar ligament and treatment of such cases

Anahtar Kelimeler

• Patellar ligament
• morphometry
• human fetus
• knee
• anatomy

Morphometry of the Patellar Ligament in Human Fetuses

Öz

Amaç: Ýnsan fetuslarýnda ligamentum patellanýn detaylý morfometrik verilerinin elde edilmesi amaçlandý. Gereç ve yöntem: Çalýþma yaþlarý 18.-32. haftalar arasýnda deðiþen, patolojisi ve anomalisi olmayan 32 insan fetusunda (18 erkek, 14 kýz) gerçekleþti. Genel eksternal ölçümlerden sonra her bir fetusun diz bölgesi diseksiyonu yapýldý. Ligamentum patellanýn komþu yapýlarla olan iliþkisi ve lokalizasyonu belirlendi. Uzunluk, geniþlik ve kalýnlýk gibi morfometrik veriler elde edildi. Bulgular: Bütün parametrelerin haftalara göre ortalamalarý ve standart sapmalarý hesaplandý. Ölçülen parametreler ile gestasyonel yaþ arasýnda anlamlý iliþki vardý (p<0.001). Cinsler arasýnda parametreler yönünden fark bulunamadý (p>0.05). Elde edilen tüm sonuçlar daha önce yapýlan çalýþmalarla karþýlaþtýrýlarak tartýþýldý. Sonuç: Çalýþmamýzda elde edilen verilerin fetal dönemde ligamentum patella geliþimi ile ilgili anomali, patoloji ve varyasyonlarýn belirlenmesinde obstetri, perinatoloji, adli týp ve fetopatoloji gibi bilim dallarýndaki çalýþmalara, teþhis ve tedavilere katkýda bulunabileceðini düþünmekteyiz.

Anahtar Kelimeler

• Ligamentum patella
• morfometri
• insan fetusu
• diz
• anatomi

Kaynakça

1. Mahadevan V. Pelvic girdle and lower limb. In: Standring S. Gray’s Anatomy-The Anatomical Basis of Clinical Practite. Fortieth Edition. Churchill Livingstone, 2008; pp 1396–1397.
2. Pang J, Shen S, Pan WR, Jones IR, Rozen WM, Taylor GI. The arterial supply of the patellar tendon: anatomical study with clinical implications for knee surgery. Clin Anat, 2009; 22(3):371–6.
3. Luk KM, Wong NM, Cheng JC. Anthropometry of the patellar tendon in Chinese. Journal of Orthopaedic Surgery, 2008; 16(1):39–42.
4. Andrikoula S, Tokis A, Vasiliadis HS, Georegoulis A. The extensor mechanism of the knee joint: an anatomical study. Knee Surg Sports Traumatol Arthrosc, 2006; 14(3):214–20.
5. Ahmad CS, Kwak SD, Ateshian GA, Warden WH, Steadman JR, Mow VC. Effects of patellar tendon adhesion to the anteiror tibia on knee mechanics, 1998; 26(5):715–24.
6. Krevolin JL, Pandy MG, Pearce JC. Moment arm of the patellar tendon in the human knee. J Biomech, 2004; 37(5):785–8.
7. Merida-Velasco JA, Sanchez-Montesinos I, Espin-Ferra J, Merida-Velasco JR, Rodriguez-Vazquez JF, Jimenez- Collado J. Development of the human knee joint ligaments. Anat Rec, 1997; 248(2):259–68.
8. Merida-Velasco JA, Sanchez-Montesinos I, Espin-Ferra J, Rodriguez-Vazquez JF, Merida-Velasco JR, Jimenez- Collado J. Development of the human knee joint. Anat Rec, 1997; 248(2):269–78.

9. Chung CB, Skaf A, Roger B, Campos J, Stump X, Resnick D. Patellar tendon lateral femoral condyle friction syndrome: MR imaging in 42 patients, 2001; 30(12):694–7
10. Lee D, Bouffard JA. Ultrasound of the knee. Eur J Ultrasound, 2001; 14(1):57–71.
11. Messina D, Meister K, Montgomery WJ. Bilateral congenital absence of patellar tendon. AM J Knee Surg, 1997; 10(1):23–5.
12. Koyuncu E, Cankara N, Sulak O, Özgüner G, Albay S. The morphometry of patella and patellar ligament during the fetal period. 2011; 24(2):225-31
13. Fredberg U, Bolvig L, Andersen NT, Stengaard- Pedersen K. Ultrasonography in evaluation of Achilles and patella tendon thickness. Ultraschall Med, 2008; 29(1):60–5.
14. Amlang MH, . Damage to large tendons: Achilles, patellar and quadriceps tendons. Chirurg, 2006; 77(7):637–49.
15. Muratli HH, , Hapa O, Biçimoðlu A. Bilateral patellar tendon rupture in a child: a case report. Knee Surg Sports Traumatol Arthrosc, 2005; 13(8):677–82.
16. Nevret P, Robinson AH, Le Coultre B, Lapra C, Chambat P. Patellar tendon length-the factor in patellar instability? Knee, 2002; 9(1):3–6.
17. Basso O, Johnson DP, Amis AA. The anatomy of the patellar tendon. Knee Surg Sports Traumatol Arthrosc, 2001; 9(1):2–5.
18. Duri ZA, Aichroth PM, Wilkins R, Jones J. Patellar tendonitis and anterior knee pain. M J Knee surg, 1999; 12(2):99–108.
19. Yu JS, Petersilge C, Sartoris DJ, Pathria MN, Resnick D. MR imaging of injuries of the extensor mechanism of the knee. Radiographics, 1994; 14(3):541–51.
20. Sell S, Esenwein S, Gaissmaier C, Moosmaier J, KüsswetterW. Ultrasound imaging of the patellar tendon--an experimental study. Z Orthop Ihre Grenzgeb, 1997; 135(3):261–5.
21. Yoo JH, Yi SR, Kim JH. The geometry of patella and patellar tendon measured on knee MRI. Surg Radiol Anat, 2007; 29(8):623–8.
22. El-Khoury GY, Wira RL, Berbaum KS, Pope TL Jr, Monu JUV. MR imaging of patellar tendinitis. Musculoskeletalradiology, 1992; 184(3):849–54.
23. Garau G, Rittweger J, Mallarias P, Longo UG, Maffulli N. Traumatic patellar tendinopathy. Disabil Rehabil, 2008; 30(20–22):1616–20.
24. Moholkar K, Taylor D, O'Reagan M, Fenelon G. A biomechanical analysis of four different methods of harvesting bone-patellar tendon-bone graft in porcine knees. J Bone Joint Surg Am, 2002; 84-A(10):1782–7.
25. Atkinson PJ, Oyen-Tiesma M, Zukosky DK, DeCamp CE, Mackenzie CD, Haut RC. Patellar tendon augmentation after removal of its central third limits joints tissue changes. J Orthop Res, 1999; 17(1):28–36.
26. Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med, 2002; 30(3):447–56.
27. Freedman KB, D'Amato MJ, Nedeff DD, Kaz A, Bach BR Jr. Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med, 2003; 31(1):2–11.
28. Basso O, Amis AA, Race A, Johnson DP. Patellar tendon fiber strains: their differential responses to quadriceps tension. Clin Orthop Relat Res, 2002; (400):246–53.
29. Moore KL, Persaud TVN. The Developing Human (Clinically Oriented Embryology), 7th edn. WB Saunders Company, Philadeýphia, 2003; pp 255–286.
30. Paulos LE, Wnorowski DC, Greenwald AE. Infrapatellar contracture syndrome. Diagnosis, treatment, and long-term followup. Am J Sports Med, 1994; 22(4):440–9.
31. Zwerver J. Patellar tendinopathy ('jumper's knee'); a common and difficult-to-treat sports injury. Ned Tijdschr Geneeskd, 2008; 152(33):1831–7.
32. Hoksrud A, Ohberg L, Alfredson H, Bahr R. Color doppler ultrasound findings patellar tendinopathy