Do Patients Really Have Pain with Quadriceps Fat Pad Edema? Author profile Search articles by ORCID 0000-0002-3805-4245 Yuksel Y1, Tarkan Ergun Quadriceps fat pad oedema and impingement syndrome are different entities. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-77665. 2013;42(1):E9-11. Quadriceps fat pad syndrome is a diagnosis of exclusion which must be considered in a highly active patient with persistent anterior knee pain and without evidence of trauma or internal joint derangement. Each has shown mild improvement of his or her symptoms. The presence of the articular muscle was recorded, and maximal anteroposterior thickness, if present, was measured. Unable to process the form. There was no association between quadriceps fat pad mass effect and anterior cruciate ligament (2 = 0.3410, p = 0.8433), posterior cruciate ligament (2 = 0.4166, p = 0.5187), medial collateral ligament (2 = 1.3235, p = 0.254), or lateral collateral ligament findings (2 = 0.4166, p = 0.5181). In the 14 patients with anterior knee pain at physical examination, the average anteroposterior quadriceps fat pad thickness was 8.1 mm (range, 5.612.2 mm), and mass effect of the quadriceps fat pad was present in 36% (5/14). After we excluded patients with prior knee ligament reconstruction, prior extensor mechanism repair, or evidence on MRI of prior knee surgery, the study group consisted of 92 knee MR images from 84 patients. The finding of quadriceps fat pad mass effect on the suprapatellar recess was significantly associated with anterior knee pain at physical examination. With regard to the quadriceps fat pad, the presence of mass effect on the suprapatellar recess was recorded, evident by convex posterior contour. We acknowledge limitations to this study, which was retrospective without IV gadolinium administered to our patients. Anterior tendon abnormalities include quadriceps and patellar tendon tear and degeneration [1, 2]. A 32-year-old man was referred to a radiology department for intermittent anterior knee pain and swelling for approximately 6 months. Of the 11 quadriceps fat pads with mass effect on the suprapatellar recess, 91% (10/11) had signal intensity greater than fat (9/11 were intermediate signal and 1/11 were fluid signal). Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know, Original Research. 2009 Jul;28 (7):959-62. doi: 10.7863/jum.2009.28.7.959. (2018) Case reports in orthopedics. Yavuz Yuksel Department of Radiology, Faculty of Medicine, Alaaddin Keykubat University, Alanya, Turkey. It is the smallest fat pad and triangular-shaped with average size of 8 2 mm in men and 7 2 mm in women [ 3 ]. . 1. It fills the gap between the posterior part of the quadriceps tendon insertion and the retropatellar cartilage covering the proximal pole of the patellar base [ 3 ]. Quadriceps fat pad edema or impingement syndrome is an inflammatory process within the quadriceps fat pad and may be analogous to Hoffa disease of the infrapatellar fat pad. Search 205,922,991 papers from all fields of science. This technique is designed to tilt the patellar so the top half of the knee cap moves towards the thigh bone, with the lower half subsequently moving further away from the shin bone, reducing compression of the patella on the fat pad. 2013;200(3):W291-W296. Quadriceps fat-pad impingement syndrome: MRI findings A. Ba, O. Tutar, +1 author C. Samanci Published 10 December 2012 Medicine BMJ Case Reports A 32-year-old man was referred to a radiology department for intermittent anterior knee pain and swelling for approximately 6 months. The term "quadriceps fat pad edema" has been used to describe an inflammatory process within the suprapatellar fat, manifested on magnetic resonance imaging (MRI) as high T2 signal, low T2 signal, and mass effect on the quadriceps tendon. 17 (3): 195-202. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Scola F, Anterior suprapatellar fat pad impingement syndrome. Superolateral Hoffa's Fat Pad Edema: Association With Patellofemoral Maltracking and Impingement, Review. Synovitis was considered present in 11% (10/92) and absent in 89% (82/92). 2). 2). With regard to the quadriceps fat pad on MRI, mass effect on the suprapatellar recess was noted in 12% (11/92) (Fig. 195 (6): 1367-73. There is no significant correlation with patellofemoral maltracking 8. Retrospective review of clinical notes indicated the presence of defined anterior knee pain by history in 18% (17/92) and at physical examination in 15% (14/92). Indications and Specications for Ultrasound Guided Procedures Ultrasound has become an indispensable tool for image guidance of interventional procedures within the MSK system. (2018) Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 10. This morphologic change in the fat pad results in mechanical impingement between the femur and the tibia. In addition, the quadriceps fat pad may appear to be of intermediate or fluid signal intensity. The term 'quadriceps fat-pad impingement' has been used to describe an inflammatory process within the anterior suprapatellar fat, manifested on MRI as high T2 signal, low T1 signal and mass effect on the quadriceps tendon. 8. As quadriceps fat pad signal increased to intermediate signal and fluid signal on fluid-sensitive sequences, mass effect was more likely to be present. . Abnormalities of the infrapatellar fat pad have also been described [4]. Edema and convex posterior surface of the quadriceps (anterior suprapatellar) fat pad. The patellar tendon showed normal appearance in 67% (62/92), tendinosis in 32% (29/92), partial-thickness tear in 1% (1/92), and full-thickness tear in 0% (0/92). 2016;100(1):78. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Review. 2006;35(5):269-274. 7. Author(s): Filip M. Vanhoenacker,Mario Maas,Jan L.M.A. The relationship between quadriceps fat pad syndrome and patellofemoral morphology: a case-control study Authors Yavuz Yuksel 1 , Tarkan Ergun 1 , Ebru Torun 1 , Melih Unal 2 , Lena Sonnow 3 , Ozkan Kose 4 Affiliations 1 Department of Radiology, Faculty of Medicine, Alaaddin Keykubat University, Alanya, Turkey. However, infrapatellar fat pad enlargement and edema from trauma and impingement have been described in Hoffa's disease [4]. An additional reviewer retrospectively measured various structures on the MR images. In addition, the maximal anteroposterior thickness of the quadriceps fat pad was measured and recorded. Joint fluid was also graded as physiologic (< 5 mm distention of the suprapatellar recess), small (5-mm to 1-cm distention), and large (> 1 cm distention). In addition, surgical proof of the data gathered from MRI reports was not obtained. However, none of the patients with enlargement of the quadriceps fat pad had direct trauma or overuse. MATERIALS AND METHODS. Because of the small number of patients with anterior knee pain and quadriceps fat pad enlargement, no conclusions can be drawn from these clinical data. However, most of the time that the Infrapatellar Fat Pad is removed/debrided is to aid visualization of the joint for whatever else is being treated intra-articularly, but/and it may also be a portion of an Arthroscopic Synovectomy (Limited or Extensive) for some synovial disease/disorder. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-52863. Imran Khan, Tanweer Ashraf, Asif Saifuddin. In addition, one patient had intraarticular corticosteroid injection followed by three Synvisc injections (hylan G-F 20, Wyeth-Ayerst Pharmaceuticals), and another had an intraarticular injection of some unknown medication. https://epos.myesr.org/poster/esr/ecr2017/C-1672, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, Anterior suprapatellar fat pad impingement syndrome. Prefemoral fat pad impingement syndrome, also known as supratrochlear / posterior suprapatellar fat pad impingement syndrome, is one of the fat pad impingement syndromes of the knee, specifically involving the prefemoral fat pad. One reviewer who did not prospectively interpret the MR images reviewed the MRI reports retrospectively and recorded information concerning the meniscus (no tear, equivocal tear, definite tear), anterior cruciate ligament (normal, partial-thickness tear, full-thickness tear), posterior cruciate ligament (normal, abnormal), and medial and lateral collateral ligaments (normal, abnormal). This MR appearance is analogous to Hoffa's disease described in the infrapatellar fat pad. It originates from the femur as one to seven muscle bundles and inserts on the suprapatellar recess, where it applies tension to the suprapatellar recess during knee extension, protecting the relatively redundant suprapatellar recess from entrapment between the femur and the patella [9]. Each of the MR images was prospectively interpreted, and the findings were reported by one of six musculoskeletal fellowship-trained radiologists as part of their daily clinical assignment. American journal of roentgenology. The quadriceps (suprapatellar) fat pad (QFP) is an extrasynovial structure bordered anteriorly by the quadriceps tendon and posteriorly by the suprapatellar recess of the knee joint [1].. However, the range (5.612.2 mm) of quadriceps fat pad thickness in patients with anterior knee pain at physical examination did overlap the range (410.5 mm) of those patients without anterior pain and the data (49 mm) of earlier studies [5]. Anterior suprapatellar (quadriceps) fat pad impingement syndrome is a controversial cause of anterior knee pain although anterior suprapatellar fat pad edema may often, and possibly more commonly, be incidental 1,2 . Semantic Scholar extracted view of "Quadriceps fat pad" by A. Murphy et al. 2. Therefore, the posterior surface of the quadriceps fat pad and a segment of the distal quadriceps tendon are lined with synovium [5]. Anterior knee pain revealed by history or at physical examination was not associated with this finding in our study population. 2. Complete pain resolution can be achieved with ultrasound-guided injection of anesthetic or corticosteroid followed by physical therapy 6. J Knee Surg. It is not known if direct quadriceps fat pad injection or surgical resection has any benefits because neither was performed in our patients. One final theory of quadriceps fat pad enlargement is that of a primary or intrinsic cause. The pat pad is normally mobile and moves out of the joint spaces of the knee normally as the knee bends and straightens. The relationship between quadriceps fat pad syndrome and patellofemoral morphology: a case-control study. QFP edema characterized by diffuse enlargement on magnetic resonance imaging (MRI) may be analogous to Hoffa's disease of the infrapatellar fat pad [ 2 ]. Posted on 06th Feb 2018 / Published in: Knee. ADVERTISEMENT: Supporters see fewer/no ads. They found that this abnormality represented injury or inflammation of the infrapatellar plica (or ligamentum mucosum) and can be a potential cause for knee pain or hemarthrosis [7]. 2013;200(3):W291-6. A. Arslan, S. Ulus, S. A. Kara, O. Saygili. Patella Hypermobility - the patella may have a large amount of movement which can impinge the fat pad. fall from a height or due to a collision in contact sports) with severe elbow pain, loss of function, swelling, deformity and often associated with one or more fractures. If you happen to have a more severe, direct impact on your kneecap, the fat pad can become impinged (pinched). These findings suggest that the edema signal observed in the superolateral portion of Hoffa's fat pad is the result of abnormal friction and mechanical impingement of the fat pad between the lateral femoral condyle and the patellar tendon, as previously postulated by Chung et al. (quadriceps) fat pad was evaluated in 770 consecutive MR examinations (on 1.5 T and 0.3 T) in 736 patients (353 females and . In this setting, sagittal MR images best demonstrate the diagnostic findings of edematous signal alterations and mass effect of the quadriceps fat pad. Suprapatellar Fat-Pad Mass Effect: MRI Findings and Correlation With Anterior Knee Pain, Review. The quadriceps (suprapatellar) fat pad (QFP) is an extrasynovial structure bordered anteriorly by the quadriceps tendon and posteriorly by the suprapatellar recess of the knee joint [ 1 ]. The purpose of this investigation was to characterize the MRI appearance of the quadriceps fat pad and to correlate the findings with other knee abnormalities, anatomic measurements of the extensor mechanism, and findings from history and at physical examination. Fat Pad Impingement. Three normal fat pads are located about the anterior knee: the quadriceps (anterior suprapatellar), the prefemoral (posterior suprapatellar or supratrochlear), and Hoffa (infrapatellar) fat pads [46]. No significant relationship was seen between patient age and mass effect (p = 0.20) or fat pad size (p = 0.96). However, no association suggested this cause. AJR. It gets stuck between the femoral condyle and the patella. The patient denied any history of major trauma, fracture or infection. With regard to the lateral facet of the patella, 40.2% (37/92) were normal; 28.3% (26/92) showed grade 1 chondromalacia; 9.8% (9/92), grade 2; 5.4% (5/92), grade 3; and 16.3% (15/92) showed grade 4 chondromalacia on MRI. In this setting, sagittal MR images best . 2). 1. 1 To our knowledge, there are no reports of quadriceps fat pad edema as shown on sonography. In this syndrome, the posterior border of the anterior suprapatellar (quadriceps) fat pad is high signal . Another limitation is lack of histologic or pathologic data regarding quadriceps fat pad abnormalities. AJR Am J Roentgenol. Clinical data were reviewed for findings of anterior knee pain in the history and at physical examination. Radiology (ESSR), and American Institute of Ultrasound in Medicine (AIUM) serve as a framework for proper utilization of ultrasound in clinical PM&R practice [5]. Draghi F, Ferrozzi G, Urciuoli L, Bortolotto C, Bianchi S. Hoffa's fat pad abnormalities, knee pain and magnetic resonance imaging in daily practice. The quadriceps or suprapatellar fat pad is a normal fat pad, positioned between the distal quadriceps tendon anteriorly and the suprapatellar recess posteriorly. In addition, no association was found between thickness of the articular muscle and quadriceps fat pad enlargement. The articular muscle was visualized in 80% (74/92), ranging from 1- to 8-mm anteroposterior thickness. The quadriceps tendon showed normal appearance in 60% (55/92), tendinosis in 40% (37/92), partial-thickness tear in 0% (0/92), and full-thickness tear in 0% (0/92). 6. Radiographics. Loss of Council on Sports Medicine and Fitness eccentric quadriceps strength in the postopera- (Table 3.1) is most commonly used and quite use- tive phase of anterior cruciate ligament . 2022;51(7):1425-32. With regard to joint effusion and synovitis, joint fluid was considered physiologic or absent in 39% (36/92), small in 37% (34/92), and large in 24% (22/92). In the assessment of chondromalacia, the medial facet of the patella was normal in 53% (49/92), whereas 15% (14/92) showed grade 1 chondromalacia; 9% (8/92), grade 2; 12% (11/92), grade 3; and 11% (10/92) showed grade 4 chondromalacia on MRI. Other data from the retrospective review included infrapatellar and prefemoral fat pad signal intensity, quadriceps and patellar tendon abnormalities, joint effusion, medial plica, chondromalacia, articular muscle thickness, and prepatellar edema. Quadriceps fat pad impingement should be considered in chronic anterior knee pain. Professional Treatment for Fat Pad Impingement Resting the knee while avoiding all activities that apply pressure to the anterior knee and/or increase symptoms. Enlargement of the quadriceps fat pad on MRI has a prevalence of 12% and is significantly associated with intermediate or fluid signal intensity of the quadriceps fat pad and anterior knee pain. Quadriceps fat pad mass effect on the suprapatellar recess was associated with quadriceps fat pad signal intensity (2 = 7.19, p = 0.0274). Patellar and trochlear chondromalacia was graded from 0 to 4 (0, normal; 1, signal abnormality without defect; 2, defect < 50% of cartilage thickness; 3, defect > 50% of thickness; 4, full-thickness defect) [8]. Since the fat pad is one of the most sensitive areas within the knee, it is thought to be quite painful. You can use Radiopaedia cases in a variety of ways to help you learn and teach. In the first manuver, keeping the leg straight, flex the hip up to 90 degrees, looking for pain in the posterior/buttocks region. [7] described the MRI findings of curvilinear or globular fluid signal in the Hoffa fat pad in five patients. 11. Check for errors and try again. 1. Enter the email address you signed up with and we'll email you a reset link. Institutional review board approval was obtained before the initiation of this investigation. Ozdemir Z, Aydingoz U, Korkmaz M et al. The quadriceps (suprapatellar) fat pad (QFP) is an extrasynovial structure with a triangular shape and is one of the fat pads located in the anterior knee . Fig. MRI reports were reviewed for meniscal and ligament abnormalities. KNEE FAT PAD IMPINGEMENT MRI APPEARANCE MRI OF FAT PAD IMPINGEMENT AROUND THE KNEE There are four fat pads around the knee that can become impinged and can be symptomatic. There was a statistically significant association between anterior knee pain at physical examination and the presence of quadriceps fat pad mass effect on the suprapatellar recess (2 = 8.76, p = 0.0031). Subhawong TK, Eng J, Carrino JA, Chhabra A. Superolateral Hoffa's fat pad edema: association with patellofemoral maltracking and impingement. A similar phenomenon occurring at the level of the superior . The etiology is unclear. They found that the finding of quadriceps fat pad mass effect on the suprapatellar recess was significantly associated with anterior knee pain at physical examination. In anterior suprapatellar fat pad impingement syndrome, the cause is usually due to either a developmental cause related to the anatomy of the extensor mechanism or may be related to abnormal mechanics. Copyright 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. dr.ahmetbas@hotmail.com The average anteroposterior measurement of the quadriceps fat pad from the 92 knees was 7.5 mm (range, 412.2 mm). With regard to knee ligaments, the anterior cruciate ligament was abnormal in 17% (16/92) (partial-thickness tear in 2/92 and full-thickness tear in 14/92), the posterior cruciate ligament was abnormal in 3% (3/92), the medial collateral ligament was abnormal in 23% (21/92), and the lateral collateral ligament was abnormal in 3% (3/92). The anterior suprapatellar fat pad shows edema with increased signal intensity with a slightly convex posterior surface. There were no significant associations between quadriceps fat pad mass effect and joint effusion (2 = 4.8530, p = 0.0883), synovitis (2 = 0.0404, p = 0.8408), or prepatellar edema (2 = 2.7803, p = 0.3534). Initial management is usually conservative, like anti-inflammatory medications and decreased painful activities. This finding could suggest a developmental cause related to the anatomy of the extensor mechanism or possibly abnormal mechanics. The quadriceps or suprapatellar fat pad is a normal fat pad, positioned between the distal quadriceps tendon anteriorly and the suprapatellar recess posteriorly. The patellar length, patellar articular length, patellar tendon length, and femoral sulcus angle were measured. You can also filter price, timings, airports and more to find the best route to Istanbul that suits your needs. IV gadolinium compound was not administered in our patients; we might have gained further information by this addition. Elbow-flexion exercises (for example, Figure 1) primarily involve flexing your elbow against resistance, with differences between the exercises including where you keep your elbow (either in front of your body, by your side, behind your body, or out to your side) and which type of grip you use (either a supinated, neutral, or . Anterior suprapatellar fat pad impingement syndrome, anterior suprapatellar fat pad impingement syndrome, Fat pad impingement syndromes of the knee. By using our flight comparison tool, you'll be able to find your flight selection at the cheapest price available on the market. There were no significant associations between quadriceps fat pad mass effect and quadriceps tendon findings (2 = 0.8613, p = 0.3534) or patellar tendon findings (2 = 0.2573, p = 0.8793). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. CONCLUSION. However, none of the patients in the study by Roth had a history of direct trauma or overuse. Right: normal anterior suprapatellar fat pad Case Discussion The anterior suprapatellar fat pad is an intracapsular, but extrasynovial structure, located just posterior to the quadriceps tendon, anterior to the prepatellar joint recess, and superior to the patellar base and retropatellar cartilage, usually triangular in shape. 2018;17(3):195-202. When we evaluated the presence or absence of quadriceps fat pad mass effect, no significant differences were found in the measurements of patellar length (p = 0.4164), patellar articular length (p = 0.5859), patellar tendon length (p = 0.7587), and anterior femoral sulcus angle (p = 0.8350). . The Hoffa fat pad was equal to fat in 89% (82/92), intermediate signal in 3% (3/92), and fluid signal in 8% (7/92) (Fig. 2018: 3583049. Associated minimal effusion in the suprapatellar recess. It has been shown that at high knee flexion angles, patellofemoral contact is at the proximal patellar pole [10] and the suprapatellar fat pad articulates with the trochlea [5]. Left: anterior suprapatellar fat pad edema, Right: normal anterior suprapatellar fat pad. On further review of the patients with anterior knee pain found at physical examination and quadriceps fat pad enlargement seen on MR images, we attempted to find a common underlying factor such as a patient's body habitus or occupation, especially given bilateral involvement in one patient. First described in 1904, acute or repetitive trauma to the fat pad causes internal hemorrhage leading to an inflammatory cascade with edema and hypertrophy of the fat pad. With regard to the trochlea of the femur, 66% (61/92) were normal; 8% (7/92) showed grade 1 chondromalacia; 10% (9/92), grade 2; 4% (4/92), grade 3; and 12% (11/92) showed grade 4 chondromalacia on MRI. RESULTS. Dec/2022: Grey goos vodka Umfangreicher Kaufratgeber Die besten Grey goos vodka Beste Angebote Testsieger Direkt weiterlese. 2012;2012(dec09 1):bcr2012007643-bcr2012007643. Link to video demonstrating this. 2) and absent in 2% (2/92). The femoral sulcus angle (angle of the anterior trochlear groove) was measured on the axial sequence at a space approximately 10 mm above the distal femur. Increased signal intensity of the suprapatellar fat pad, with a convex posterior border and mass effect over the suprapatellar joint recess. The two radiologists also gathered the following retrospective data by consensus: The signal intensity of the prefemoral fat pad and Hoffa fat pad was recorded as equal to fat, intermediate signal (equal to muscle or cartilage), or fluid signal on proton densityweighted fat-saturation MR images. Authors Brian Van Le 1 , Srinivasan Harish Affiliation 1 Department of Radiology, McMaster University, Ontario, Canada. Faour M, Ramkumar PN, Yakubek G, Khlopas A, Chughtai M et al. The infrapatellar fat pad is an intracapsular structure and plays a role in stabilizing the patella in extremes of flexion and extension. K Distance: 472 kms. MR images were retrospectively reviewed by two fellowship-trained radiologists (experience, 8 and 9 years) with an opinion rendered by consensus. Skeletal Radiol. DOI: 10.53347/rid-77638; Imaging findings and symptoms need to be present for diagnosis. Ulnar Nerve Compression. Flores D, Meja Gmez C, Pathria M. Layered Approach to the Anterior Knee: Normal Anatomy and Disorders Associated with Anterior Knee Pain. At the distal thigh, the tendons of these muscles merge to form the quadriceps tendon. The anterior suprapatellar fat pad is edematous compared to the prefemoral fat pad, enlarged (10 mm AP diameter) with a mass effect on the adjacent suprapatellar recess (i.e. Compression of the ulnar nerve as it passes the inner aspect of the elbow (figure 10) often due to a direct impact or. Therefore, one analogous theory is that of quadriceps fat pad impingement. Quadriceps and anterior hip stretching is found to improve IFP restriction symptoms . The quadriceps fat pad was of intermediate or fluid signal intensity in 54%. separates it from the prefemoral fat pad [10-13]. Search. 2017;30(7):639-46. . Two of the five enlarged quadriceps fat pads in patients with anterior knee pain occurred bilaterally in one patient. It fills the gap between the quadriceps tendon, the * Benedikt J. Schwaiger bschwaiger@gmx.com 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Suite 350, San . Objective: While clinically reading magnetic resonance (MR) images of the knees we have occasionally noted edema within the suprapatellar fat pad, with mass effect both on the suprapatellar joint recess posteriorly, and on the quadriceps tendon anteriorly. A recent study reported an association with patellofemoral joint degeneration 9. Presence or absence of prepatellar edema (fluid signal on proton densityweighted MR images) was noted. If one assumes that there is a progression of signal intensity of the quadriceps fat pad from fat to intermediate signal to fluid signal, then the proportion of individuals with mass effect increases as fat pad signal changes progress to fluid signal (2 = 7.18, p = 0.0074). ORTHOPEDIC MCQS BANK WITH ANSWER ANATOMY 02. -. This injury affects at least one ligament that connects the fibula and tibia bones being sprained. 4. Anterior knee pain at physical examination was also significantly associated with an abnormal medial collateral ligament (2 = 4.83, p = 0.0031) and anterior knee pain by history (2 = 22.76, p < 0.0001). Incidentally, we found a similar abnormality in 8% (7/92) of our patients (Fig. Skeletal Radiol. Surgery could be considered in cases with persistent symptoms by laparoscopic resection 7. 2. With regard to measurements of anatomic structures, the average patellar length was 41.2 mm (range, 32.851.4 mm), the average patellar articular length was 30.6 mm (range, 21.537.9 mm), and the average patellar tendon length was 45.7 mm (range, 30.460.9 mm).