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Intraosseous Innervation of the Human Patella

A Histologic Study

R. Shane Barton, MD^*, Mary L. Ostrowski, MD, Terrence D. Anderson^*, Omer A. Ilahi, MD^* and Michael H. Heggeness, MD, PhD^*,

From the ^* departments of Orthopedic Surgery and Pathology, Baylor College of Medicine, The Methodist Hospital, Houston, Texas

Address correspondence to Michael H. Heggeness, MD, PhD, Department of Orthopedic Surgery, Baylor College of Medicine, 1709 Dryden, 12^th floor, Houston, Texas 77030; e-mail: heggeness{at}bcm.tmc.edu.

Background: The soft tissue structures surrounding the human knee joint have been the subject of extensive anatomic study. The detailed histologic findings within the bone of the human patella, however, have not been systematically studied. While the nerves supplied to the periarticular soft tissues have been very well documented, the nerves supplied to the interior of the bony patella have never been described.

Hypothesis: This study tests the hypothesis that the patella contains an intraosseous nerve network. Further, the authors investigate the anatomic location of these intraosseous nerves to better understand their possible clinical relevance.

Study Design: Descriptive laboratory study.

Methods: Ten matched pairs of cadaveric patellae (left and right patellae from the same individual; 20 total) were prepared for evaluation by hematoxylin and eosin staining using a technique that allows the creation of complete, large histologic sections of individual patellae. The matched specimens were dissected free of soft tissue and then sectioned using a diamond-wafering saw into 3-mm sagittal (left patella) and transverse (right patella) sections. Sections were then decalcified and whole-mounted into paraffin blocks for further sectioning using a large-format microtome. All 20 specimens were prepared for evaluation. Age at death averaged 80 years (range, 64–91). All specimens demonstrated at least grade II chondromalacia.

Results: Nineteen of 20 (95%) specimens demonstrated intraosseous nerves. Of 248 sections studied, 116 (47%) demonstrated intraosseous nerves, with 227 individual nerves identified. The density of intraosseous nerves was greatest in the medial and central portions of the patella, with a significant paucity identified laterally.

Conclusion: The primary intraosseous innervation of the patella derives from a medially based neurovascular bundle.

Clinical Relevance: A better understanding of the nerves within the human bony patella may improve understanding the patho-physiology of anterior knee pain syndromes.

Key Words: patella • nerve • anatomy • histology • intraosseous nerve