3 years ago

Anatomie et tendinopathie patellaire : un malentendu

M. Bouvard, C. Marion, A. Lippa, M. Montaudon

Publication date: Available online 7 November 2018

Source: Journal de Traumatologie du Sport

Author(s): M. Bouvard, C. Marion, A. Lippa, M. Montaudon

Résumé

La structure anatomique unissant la patella au tibia porte à présent la dénomination internationale de « ligament patellaire ». Si le terme paraît consacré, son choix peut être source de confusion auprès des confrères non experts. En effet, le rôle de cette structure n’est pas en priorité la stabilité articulaire du genou comme les ligaments croisés ou collatéraux mais une prolongation de l’action mécanique du quadriceps vers le squelette jambier au-delà du « sésamoïde patellaire ». Les atteintes de ce que nous nommerons le tendon patellaire sont très fréquentes en pathologie sportive. Une majorité de ces atteintes touche le tiers proximal sous la pointe de la patella. Cette très fréquente tendinopathie continue d’être décrite comme tendinopathie d’insertion. À partir de la relecture de 100 IRM consécutives du genou et de dissection cadavérique, nous confirmons que l’insertion du tendon patellaire a lieu sur la face antérieure de la patella et non la pointe. Nous décrivons également deux variantes anatomiques du tendon patellaire sain (type 1 et 2) qu’il convient de ne pas confondre avec un foyer de tendinopathie. Les limites anatomiques entre le tissu tendineux et le corps adipeux infra-patellaire (lig. adipeux de Hoffa), notamment sur le tiers supérieur, manquent encore de clarté et méritent d’autres travaux.

Abstract

The anatomical structure linking the patella and the tibia is called the “patellar ligament” in the international nomenclature. This term is well accepted yet can be a source of confusion for non-specialists. This is because the priority role of this structure is not to maintain joint stability, the primary role of the cruciate ligaments and the collateral ligaments, but rather to prolong the mechanical action of the quadriceps muscle onto the leg skeleton beyond the “patellar sesmoid”. Patellar tendon injuries are a common observation in sports medicine. The proximal third of the tendon below the patella is most generally involved. This highly frequent tendinopathy sometimes termed an “insertion” tendiopathy. Based on 100 consecutive magnetic resonance imaging studies and cadaveric dissection, we confirm that the insertion of the patellar tendon is situated on the anterior aspect of the patella and not the tip. We describe two anatomical variants of the healthy patellar tendon (type 1 and 2) that should not be confused with a site of tendinopathy. The anatomical limits between tendinous tissue and infrapatellar adipose body (the Hoffa adipose ligament), notably on the upper third is still debated and merits further work.

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