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. 2026 Mar 10;13(1):e70668.
doi: 10.1002/jeo2.70668. eCollection 2026 Jan.

Greater medial arterial supply revealed by 7-Tesla quantitative magnetic resonance imaging, histology and high-resolution computed tomography of the patellar tendon

Maximilian M Mueller  1   2 , Craig E Klinger  1 , Sebastian Conner-Rilk  1   3   4 , Jerry Wang  5 , Kevin G Shea  6 , Gregory S DiFelice  1 , Ryan Brown  7 , Maneeza Bilal  5 , Peter K Sculco  1 , Scott A Rodeo  1   8 , Daniel W Green  1
Affiliations

Greater medial arterial supply revealed by 7-Tesla quantitative magnetic resonance imaging, histology and high-resolution computed tomography of the patellar tendon

Maximilian M Mueller et al. J Exp Orthop. .

Abstract

Purpose: To quantitatively assess relative arterial contributions to the patellar tendon (PT) across predefined anatomic regions with 7-Tesla quantitative magnetic resonance imaging (7T-qMRI), algorithm-based histological analysis and high-resolution computed tomography (micro-CT) in a cadaveric model.

Methods: Seven fresh-frozen human cadaveric knee pairs (mean age 41.9 ± 15.5 years) underwent limited vascular dissection and arterial cannulation. Pre- and post-contrast 7T-qMRI, with a volumetric interpolated breath-hold examination (VIBE) three-dimensional T1-weighted gradient echo pulse sequence, quantified tendonous vascularity by measuring contrast enhancement. Subsequent quantitative algorithm-based histologic analysis with hematoxylin and eosin (H&E) staining followed, and two additional specimens underwent high-resolution (98 μm) micro-CT for qualitative vascular assessment.

Results: In the transverse analysis, 7T-qMRI demonstrated the highest mean relative arterial contributions in the medial region (42.4%) compared with the middle region (30.2%; p = 0.035) and higher, though not significant, than the lateral region (32.0%). The central PT demonstrated greater relative arterial contributions (37.5%) than the proximal (26.5%) or distal (29.3%) thirds (p > 0.05) in the longitudinal analysis. At the patellar enthesis, the middle third exhibited higher contributions (35.3%) than medial (28.8%) or lateral (29.6%), without significance, while the tibial tuberosity showed greater contributions along the lateral region (37.2%; p > 0.05). Histology confirmed significantly greater medial arterial contribution, with 8.3% higher supply than lateral (p = 0.018). Micro-CT revealed a robust vascular network along the medial PT with smaller branches laterally. Distal to the inferior patellar pole, a peripatellar circular network, extending medially into the posterior PT layers, was qualitatively identified.

Conclusion: 7T-qMRI and histological analyses demonstrated significantly greater arterial supply along the medial border of the PT, while micro-CT revealed a medial and peripatellar circular vascular network extending from the medial margin and the inferior patellar pole into the posterior tendon layers. These findings identify the medial margin as the main vascular source for the PT, with implications for surgical preservation and reducing PT devascularization risk.

Level of evidence: N/A.

Keywords: arterial supply; parapatellar approach; patellar tendon; patellar tendon rupture; rupture; vascularity.

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Conflict of interest statement

Unrelated to this study, Kevin G. Shea serves on the Board of POSNA, holds stock options in Sarcio, Medeloop and nView, and receives research materials from Arthrex, Stryker, Evolution Surgical and Allosource. Gregory S. DiFelice receives royalties, owns stock and is a paid consultant for Zimmer Biomet. Gregory S. DiFelice receives royalties from Arthrex. Gregory S. DiFelice received stock options, provides consulting services and participates in funded research with Miach Orthopaedics. Gregory S. DiFelice receives stock options and provides consulting services for OSSIO Inc. Peter K. Sculco consults for BICMD, Inc., Enovis and Zimmer Biomet; receives royalties from Enovis and Zimmer Biomet; research support from Zimmer Biomet; serves on the advisory board of Osgenic; and holds ownership interests in BetterPT, HS2, LLC, HSS ASC Development Network, LLC, Intellijoint Surgical, Inc., Joint Effort Administrative Services Organization, LLC, Parvizi Surgical Innovation, LLC and Osgenic. Scott A. Rodeo reports consulting for Novartis, Advance Medical/Teladoc and Enovis; research support from Virginia Toulmin Foundation, OREF, Arthritis Foundation, Angiocrine Biosciences, CTSC and NIH; and stock options in Jannu Therapeutics and Overture Medical. Daniel W. Green reports roles with AONA & AO, Arthrex (consulting, royalties, speakers' bureau), OrthoPediatrics (royalties) and Wolters Kluwer (authorship). The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diagram of a right‐sided patella and patellar tendon (PT) illustrating the 7‐Tesla quantitative magnetic resonance imaging (7T‐qMRI) analysis. Regions of interest (ROI) areas include (a) proximal, central and distal ROI areas, with each ROI equal in height, and (b) medial, middle and lateral ROI areas, with each ROI equal in width.
Figure 2
Figure 2
Example 7‐Tesla quantitative magnetic resonance imaging (7T‐qMRI) was acquired along axial plane. Siemens volumetric interpolated breath‐hold examination (VIBE) MRI sequence images demonstrate pre‐ (a) and post‐contrast (b) imaging of the patella tendon (PT) including increased signal at the dorsomedial border of the PT (yellow arrows).
Figure 3
Figure 3
Diagram illustrating the mean relative vascular contributions to the patellar tendon of a right knee found in the 7‐Tesla quantitative magnetic resonance imaging (7T‐qMRI) proximal‐to‐distal analysis (a) and medial‐to‐lateral analysis (b).
Figure 4
Figure 4
High‐resolution computed tomography (micro‐CT) multiplanar (from left: axial, coronal, sagittal) reconstruction images at 98 μm resolution in maximum intensity projection (MIP) mode demonstrating patellar tendon vascularity. A substantial network of nutrient branches was observed along the medial and posterior aspect of the patellar tendon and inferior to the patella pole.
See this image and copyright information in PMC

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