Patellar bone stock after extra-articular knee resection preserving extensor mechanism: A cadaveric study

This study aimed to evaluate the thickness of the remaining patellar bone stock following extra-articular knee resection (EKR) preserving the extensor mechanism in human cadaveric knee joints.

A total of 14 human cadaveric knee joints (8 men and 2 women) were dissected, and the patellar thickness from the joint capsule insertion to the anterior cortex of the patella was measured using an electronic caliper. The mean age of the cadavers was 37 years (range=28-50). Measurements were performed by an anatomist and an orthopedic surgeon. As the total number of the cadavers was not enough to show the patellar thickness with sampling (sex and age), we endeavored to supplement the content with magnetic resonance images (MRI). Accordingly, the patellar bone thickness was also measured on axial MRI scans of 100 adult and 25 pediatric knees of patients (71 women and 54 men; mean age=36 years; age range=7-67 years) admitted to our hospital in whom meniscal tears were suspected. The rate of specimens with remaining patellar thickness of less than 10 mm after presumed resection was evaluated. The macroscopic measurements in cadavers and MRI measurements in adult knees were compared statistically.

The mean thickness of the residual patellar bone of the cadaver dissections following a presumed EKR preserving the extensor mechanism was 8.2 mm (range=3.4-15.8). Additionally, in 71.4% (10/14) of the cadaveric knees, the thickness of residual patellar bone was less than 10 mm. In MRI scans, the average thickness of residual patella after presumed resection was 8.6 mm (range: 3.6-16) in adult knees and 6.9 mm (range: 3.4-10) in pediatric knees, and the residual patellar thickness less than 10 mm after presumed resection was determined in 72% of all MRI scans. Macroscopic measurements in cadaveric knees were statistically similar to MRI scan measurements in adult knees (p=0.765, Mann-Whitney U test).

Evidence from this study revealed that the thickness of the remaining patellar bone stock after EKR preserving the extensor mechanism may be low. A preoperative assessment with MRI can guide the surgeon to select the appropriate method for knee resection in order to prevent from the complications of resected patella.