Beyond linear measurements: a comprehensive 3D CT analysis of patellar volume and density

Patellar morphology and biomechanics are essential for surgical planning, forensic identification, and knee function. This study leverages 3D CT to address gaps in population-specific data, providing a comprehensive morphometric profile of the patella and patellar ligament in a large-scale Turkish cohort. We aim to evaluate sexual dimorphism and age-related changes in these parameters to optimize implant design and clinical outcomes.

A total of 652 patellae (326 right, 326 left) were evaluated. In addition to standard linear measurements (transverse diameter, anteroposterior diameter, height, and facets), this study uniquely incorporated volumetric and bone density (Hounsfield Units) measurements along with patellar ligament dimensions and the Insall-Salvati ratio. Morphological categorization was performed according to the Wiberg classification.

The mean transverse diameter was 4.38 ± 0.38 cm. Median volume and bone density were 16.30 (9.60-30.50) cm³ and 524 (101-897) HU, respectively. Significant sexual dimorphism was observed across all morphometric and densitometric parameters, with significantly higher values in males (p < 0.001). According to the Wiberg classification, Type B was the most prevalent (64.7%), followed by Type C (24.6%) and Type A (10.7%), with no significant difference between sexes (p > 0.05).

Our results demonstrate that 3D CT-based assessment provides high-resolution reference data that can enhance the success of orthopedic procedures by minimizing prosthetic mismatch. Furthermore, the integration of volumetric and densitometric data provides a robust framework for gender determination in forensics and facilitates precise anatomical evaluation before invasive interventions.