The patella, also known as the kneecap, is a flat, rounded triangular

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...

which articulates with the

femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates wit ...

(thigh bone) and covers and protects the anterior articular surface of the knee

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

. The patella is found in many tetrapods, such as mice,

cat The cat (''Felis catus'') is a domestic species of small carnivorous mammal. It is the only domesticated species in the family Felidae and is commonly referred to as the domestic cat or house cat to distinguish it from the wild members of ...

bird Birds are a group of warm-blooded vertebrates constituting the class Aves (), characterised by feathers, toothless beaked jaws, the laying of hard-shelled eggs, a high metabolic rate, a four-chambered heart, and a strong yet lightweig ...

s and

dog The dog (''Canis familiaris'' or ''Canis lupus familiaris'') is a domesticated descendant of the wolf. Also called the domestic dog, it is derived from the extinct Pleistocene wolf, and the modern wolf is the dog's nearest living relative. Do ...

s, but not in

whale Whales are a widely distributed and diverse group of fully aquatic placental marine mammals. As an informal and colloquial grouping, they correspond to large members of the infraorder Cetacea, i.e. all cetaceans apart from dolphins and ...

s, or most reptiles. In humans, the patella is the largest sesamoid bone (i.e., embedded within a tendon or a muscle) in the body. Babies are born with a patella of soft cartilage which begins to ossify into bone at about four years of age.

Structure

The patella is a sesamoid bone roughly triangular in shape, with the apex of the patella facing downwards. The apex is the most inferior (lowest) part of the patella. It is pointed in shape, and gives attachment to the

patellar ligament The patellar tendon is the distal portion of the common tendon of the quadriceps femoris, which is continued from the patella to the tibial tuberosity. It is also sometimes called the patellar ligament as it forms a bone to bone connection when ...

. The front and back surfaces are joined by a thin margin and towards centre by a thicker margin. The

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

of the

quadriceps femoris muscle The quadriceps femoris muscle (, also called the quadriceps extensor, quadriceps or quads) is a large muscle group that includes the four prevailing muscles on the front of the thigh. It is the sole extensor muscle of the knee, forming a large ...

attaches to the base of the patella., with the vastus intermedius muscle attaching to the base itself, and the

vastus lateralis The vastus lateralis (), also called the vastus externus, is the largest and most powerful part of the quadriceps femoris, a muscle in the thigh. Together with other muscles of the quadriceps group, it serves to extend the knee joint, moving the ...

and vastus medialis are attached to outer lateral and medial borders of patella respectively. The upper third of the front of the patella is coarse, flattened, and rough, and serves for the attachment of the tendon of the quadriceps and often has exostoses. The middle third has numerous

vascular The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away f ...

canaliculi. The lower third culminates in the apex which serves as the origin of the

. The posterior surface is divided into two parts. Patella ant.jpg, Human left patella from the front Patella post.jpg, Human left patella from behind Knee Biomechanics.JPG, Flexion and extension of knee The upper three-quarters of the patella articulates with the femur and is subdivided into a medial and a lateral facet by a vertical ledge which varies in shape. In the adult the articular surface is about and covered by cartilage, which can reach a maximal thickness of in the centre at about 30 years of age. Owing to the great stress on the patellofemoral joint during resisted knee flexion, the articular cartilage of the patella is among the thickest in the human body. The lower part of the posterior surface has vascular canaliculi filled and is filled by fatty tissue, the

infrapatellar fat pad The infrapatellar fat pad (Hoffa's fat pad) is a cylindrical piece of fat that is situated under and behind the patella bone within the knee. Clinical significance The fat pad is a normal structure but it can sometimes become a problem: * It can ...

Variation

Emarginations (i.e. ''patella emarginata'', a "missing piece") are common laterally on the proximal edge.

Bipartite patella Bipartite patella is a condition where the patella, or kneecap, is composed of two separate bones. Instead of fusing together as normally occurs in early childhood, the bones of the patella remain separated. The condition occurs in approximatel ...

s are the result of an ossification of a second

cartilaginous Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck a ...

layer at the location of an emargination. Previously, bipartite patellas were explained as the failure of several ossification centres to fuse, but this idea has been rejected. Partite patellas occur almost exclusively in men. Tripartite and even multipartite patellas occur. The upper three-quarters of the patella articulates with the femur and is subdivided into a medial and a lateral facet by a vertical ledge which varies in shape. Four main types of articular surface can be distinguished: # Most commonly the medial articular surface is smaller than the lateral. # Sometimes both articular surfaces are virtually equal in size. # Occasionally, the medial surface is

hypoplastic Hypoplasia (from Ancient Greek :wikt:ὑπό, ὑπo- ''hypo-'' 'under' + πλάσις ''plasis'' 'formation'; adjective form ''hypoplastic'') is underdevelopment or incomplete development of a tissue or organ.ossification Ossification (also called osteogenesis or bone mineralization) in bone remodeling is the process of laying down new bone material by cells named osteoblasts. It is synonymous with bone tissue formation. There are two processes resulting in ...

centre develops at the age of 3–6 years. The patella originates from two centres of ossification which unite when fully formed.

Function

The primary functional role of the patella is knee extension. The patella increases the

lever A lever is a simple machine consisting of a beam or rigid rod pivoted at a fixed hinge, or '' fulcrum''. A lever is a rigid body capable of rotating on a point on itself. On the basis of the locations of fulcrum, load and effort, the lever is d ...

age that the

quadriceps tendon In human anatomy, the quadriceps tendon works with the quadriceps muscle to extend the leg. All four parts of the quadriceps muscle attach to the shin via the patella (knee cap), where the quadriceps tendon becomes the patellar ligament. It att ...

can exert on the femur by increasing the angle at which it acts. The patella is attached to the

of the

, which contracts to extend/straighten the knee. The patella is stabilized by the insertion of the horizontal fibres of vastus medialis and by the prominence of the

lateral femoral condyle The lateral condyle is one of the two projections on the lower extremity of the femur. The other one is the medial condyle. The lateral condyle is the more prominent and is broader both in its front-to-back and transverse diameters. Clinical sign ...

, which discourages lateral dislocation during flexion. The retinacular fibres of the patella also stabilize it during exercise.

Clinical significance

Dislocation

Patellar dislocations occur with significant regularity, particularly in young female athletes. It involves the patella sliding out of its position on the knee, most often laterally, and may be associated with extremely intense pain and swelling. The patella can be tracked back into the groove with an extension of the knee, and therefore sometimes returns into the proper position on its own.

Vertical alignment

A ''patella alta'' is a high-riding (superiorly aligned) patella. An

attenuated patella alta Attenuated patella alta is an extremely rare condition affecting mobility and leg strength. It is characterized by an unusually small knee cap (patella) that develops out of and above the joint. Typically, as the knee cap sits in the joint, it ...

is an unusually small patella that develops out of and above the

. A ''patella baja'' is a low-riding patella. A long-standing patella baja may result in extensor dysfunction. Insall-Salvati ratio of patella baja

The ''Insall-Salvati ratio'' helps to indicate patella baja on lateral

X-rays An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nbs ...

, and is calculated as the patellar tendon length divided by the patellar bone length. An Insall-Salvati ratio of < 0.8 indicates patella baja.

Fracture

The kneecap is prone to injury because of its particularly exposed location, and fractures of the patella commonly occur as a consequence of direct trauma onto the knee. These fractures usually cause swelling and pain in the region, bleeding into the joint (

hemarthrosis Hemarthrosis is a bleeding into joint spaces. It is a common feature of hemophilia. Causes It usually follows injury but occurs mainly in patients with a predisposition to hemorrhage such as those being treated with warfarin (or other anticoagulan ...

), and an inability to extend the knee. Patella fractures are usually treated with surgery, unless the damage is minimal and the extensor mechanism is intact.

Exostosis

exostosis An exostosis, also known as bone spur, is the formation of new bone on the surface of a bone. Exostoses can cause chronic pain ranging from mild to debilitatingly severe, depending on the shape, size, and location of the lesion. It is most commonl ...

is the formation of new bone onto a bone, as a result of excess

calcium Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar t ...

formation. This can be the cause of chronic pain when formed on the patella.

In animals

The patella is found in

placental mammals Placental mammals (infraclass Placentalia ) are one of the three extant subdivisions of the class Mammalia, the other two being Monotremata and Marsupialia. Placentalia contains the vast majority of extant mammals, which are partly distinguishe ...

and birds; most marsupials have only rudimentary, non-ossified patellae although a few species possess a bony patella. A patella is also present in the living monotremes, the

platypus The platypus (''Ornithorhynchus anatinus''), sometimes referred to as the duck-billed platypus, is a semiaquatic, egg-laying mammal endemic to eastern Australia, including Tasmania. The platypus is the sole living representative or mono ...

and the

echidna Echidnas (), sometimes known as spiny anteaters, are quill-covered monotremes (egg-laying mammals) belonging to the family Tachyglossidae . The four extant species of echidnas and the platypus are the only living mammals that lay eggs and the ...

. In more primitive tetrapods, including living amphibians and most reptiles (except some Lepidosaurs), the muscle tendons from the upper leg are attached directly to the

tibia The tibia (; ), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia); it connects ...

, and a patella is not present. In 2017 it was discovered that

frog A frog is any member of a diverse and largely carnivorous group of short-bodied, tailless amphibians composing the order Anura (ανοὐρά, literally ''without tail'' in Ancient Greek). The oldest fossil "proto-frog" ''Triadobatrachus'' is ...

s have kneecaps, contrary to what was thought. This raises the possibility that the kneecap arose 350 million years ago when tetrapods first appeared, but that it disappeared in some animals.

Etymology

The word ''patella'' originated in the late 17th century from the diminutive form of

Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...

' or ' or ''paten'', meaning shallow dish.

References

External links

{{Authority control Knee Sesamoid bones Bones of the lower limb