Cs. Ahmad et al., EFFECTS OF PATELLAR TENDON ADHESION TO THE ANTERIOR TIBIA ON KNEE MECHANICS, American journal of sports medicine, 26(5), 1998, pp. 715-724
The effects of patellar tendon adhesion on the knee extensor mechanism
and on the kinematics and contact areas for both the patellofemoral a
nd tibiofemoral joints were determined for five cadaveric knees in an
open kinetic chain testing configuration. Patellar tendon adhesion dec
reased the distance from the inferior patellar pole to the tibial tube
rosity, effectively creating patella infera. When compared with the co
ntrols, knees with adhesion had medial and distal translation of the p
atella, as well as increased patellar flexion. Although the patellar a
rticular contact location shifted distally, the overall contact area d
id not change significantly. For the tibia, adhesion resulted in signi
ficant medial, proximal, and anterior translation, and internal rotati
on. Adhesion also resulted in a posterior shift of the tibial contact
location. For the extensor mechanism, adhesion decreased the knee exte
nsion force created by the quadriceps muscle on the tibia, indicating
a decrease in the effective moment arm of the extensor mechanism. Furt
hermore, as a result of patellar tendon adhesion, the angle formed by
the quadriceps and patellar tendons decreased, suggesting an increase
in patellofemoral joint reaction force with adhesion. The increased pa
tellofemoral joint reaction force and the altered contact location may
be related to anterior knee pain after knee trauma and knee surgery.
Therefore, patients should be observed for subtle patella infera, whic
h may indicate patellar tendon adhesion.