Soft-tissue anatomy anterior to the human patella

J Bone Joint Surg Am. 2003 Jun;85(6):1012-7. doi: 10.2106/00004623-200306000-00005.


Background: The purpose of this anatomic study is to report the results of dissections of the soft-tissue structures anterior to the human patella.

Methods: Sixty-one fresh or fresh-frozen and thawed human cadaver knees were dissected for this study. Thirty-five of the knees were from men, and twenty-six were from women. The soft-tissue structures anterior to the patella were dissected layer by layer and documented photographically.

Results: Fifty-seven (93%) of the sixty-one knees were found to have a trilaminar arrangement of fibrous soft-tissue structures anterior to the patella from superficial to deep. Those structures included a transversely oriented fascia, an obliquely oriented aponeurosis, and the longitudinally oriented fibers of the rectus femoris tendon. Between the soft-tissue fibrous layers, there were three prepatellar spaces that can be termed bursae: a prepatellar subcutaneous bursa, a prepatellar subfascial bursa, and a prepatellar subaponeurotic bursa. Four of the sixty-one knees lacked an intermediate oblique aponeurotic layer. In none of the sixty-one knees was there a potential bursal space between the rectus femoris tendon and the anterior patellar bone.

Conclusions: These anatomic findings are at variance with descriptions in standard anatomic orthopaedic texts and periodical literature, including the Nomina Anatomica. None of those texts accurately describe the presence of a prepatellar aponeurotic layer or a prepatellar subaponeurotic bursa. Also, in contradistinction to descriptions in the anatomic literature, including the Nomina Anatomica, no prepatellar subtendinous bursa was found in any of the sixty-one knees.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cadaver
  • Connective Tissue / anatomy & histology
  • Dissection / methods*
  • Female
  • Humans
  • Knee / anatomy & histology*
  • Male
  • Middle Aged
  • Patella / anatomy & histology