Abstract
The patella initially ossifies at between three and five years, commencing as multiple foci that rapidly coalesce. As the patellar ossification center enlarges the expanding margins may be irregular and associated with accessory ossification centers. These are most common superolaterally and may lead to the development of a bipartite patella. The bipartite patella has cartilaginous continuity despite the appearance of osseous discontinuity. The patella expands to all cartilaginous contours during late adolescence when the epiphyseal ossification centers around the knee are also in the final stages of maturation. The only cartilage not replaced is that occupying the superior twothirds of the articular surface (the lower one-third is covered by the fat pad). The subchondral plate does not assume the actual articular contours until the late stages of osseous maturation (after ten to twelve years). Accordingly, typical measurements such as medial and lateral angulation cannot be accurately done prior to the final stages of patellar ossification expansion and maturation.
The tibial tuberosity begins ossification at between seven and nine years as a distal focus. This progressively enlarges proximally and anteriorly, while the main tibial ossification center concomitantly expands downward into the tuberosity. A section of epiphyseal cartilage usually remains between these two ossification centers until close to physeal maturity. The anterior chondro-osseous region at the site of patellar tendon attachment is a biomechanically susceptible region that may be acutely or chronically traumatized to create an Osgood-Schlatter lesion. The physis associated with the tibial tuberosity is histologically modified in a proximal to distal gradation of columnar adaptation to specific biomechanical demands in this region. Closure of the tuberosity physis occurs in a proximal to distal direction.
Similar content being viewed by others
References
Caffey J (1978) Pediatric X-ray diagnosis. Year Book Medical Publishers, Chicago
Cross MJ, Waldrop J (1975) The patellar index as a guide to the understanding and diagnosis of patelofemoral instability. Clin Orthop 110:174
George R (1935) Bilateral bipartite patella. Br J Surg 22:555
Kennedy JC (1979) The injured adolescent knee. Williams and Wilkins, St Louis
Lanscourt JE, Cristini JA (1975) Patella alta and patella infera. J Bone Joint Surg [Am] 57:1112
Oetteking B (1922) Anomalous patellae. Anat Rec 23:269
Ogden JA (1982) Skeletal injury in the child. Lea and Febiger, Philadelphia
Ogden JA (1984) Radiology of postnatal skeletal development. IX. Proximal tibia and fibula. Skeletal Radiol 11:169
Ogden JA, Southwick WO (1976) Osgood-Schlatter's disease and tibial tuberosity development. Clin Orthop 116:180
Ogden JA, Southwick WO, Hempton RF (1975) Development of the tibial tuberosity. Anat Rec 182:431
Ogden JA, Tross RB, Murphy MJ (1980) Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg [Am] 62:205
Ogden JA, McCarthy SM, Jokl P (1982) The painful bipartite patella. J Pediatr Orthop 2:263
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ogden, J.A. Radiology of postnatal skeletal development. Skeletal Radiol 11, 246–257 (1984). https://doi.org/10.1007/BF00351348
Issue Date:
DOI: https://doi.org/10.1007/BF00351348