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At least 217 records · Page 12Linked to original sources
PubMed1981

Restoration of dynamic stability of the patella by pes anserinus transposition. A new approach.

Lateral instability of the patella was found after recurrent, habitual and permanent dislocations. Contracture of soft tissues lateral to the patella only occurred with habitual and permanent dislocations, but medial laxity was present in all cases. After adequate release of the lateral contracture, the medial stability was improved by transposition of the lower three-quarters of the pes anserinus to the medial border of the patella, and the patellar ligament. This created a relatively unstretchable physiological sling which ensured dynamic stability of the patella. Six recurrent, 21 habitual and nine permanent dislocations of the patella were treated by this method. Results were excellent in 21 patients, good in 13 and fair in two. The follow-up period varied from 21 to 84 months. There have been no recurrences to date.

Adolescent↗
PubMed2003

Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella.

Comminuted and displaced fractures of the inferiorole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. We have evaluated the clinical effectiveness of the separate vertical wiring technique in acute comminuted fractures of the inferior pole of the patella. A biomechanical study was also performed using ten pairs of embalmed cadaver knees. A four-part fracture was made on the inferior pole of the patella and fixed by two separate vertical wires on one side and two pull-out sutures after partial patellectomy on the other. The ultimate load to failure in the first group was significantly higher than in the second (250.1+/- 109.7 N v 69.7 +/- 18.9 N, p < 0.002), as was the stiffness (279.9 +/- 76.4 N/mm v 23.2 +/- 11.4 N/mm, p < 0.001). The separate wire technique was used in 25 patients with comminuted fractures of the inferior pole of the patella who were followed up for a mean period of 22 months (10 to 50). All the fractures healed at a mean of seven weeks (6 to 10). No breakage of a wire or infection occurred. The mean grading at the final follow-up was 29.5 points (27 to 30) using the Böstman method. This technique preserved the length of the patella, fixed the comminuted fragments of the inferior pole and avoided long-term immobilisation of the knee.

Adolescent↗
PubMed1994

Painful bipartite patella. A new approach to operative treatment.

Thirteen patients who had fifteen painful bipartite patellae were managed with a new operative technique in which the vastus lateralis insertion to the painful patellar fragment is detached subperiosteally while the continuity of the tendon-periosteum complex to the main portion of the patella is preserved. A grossly mobile patellar fragment was removed from five patellae (three type-II and two type-III according to the classification of Saupe). A fragment that showed minimum mobility was left in situ in seven type-III and three type-II patellae. All of the patients had prompt relief of the pain and returned to full sports activity within two months after the operation. Six of the seven type-III fragments that had not been removed united by bone to the main portion of the patella within two years postoperatively, but all three type-II fragments failed to unite. Over-all, eleven patients (thirteen knees) had an excellent result at an average of five years postoperatively.

Adolescent↗
PubMed2003

Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study.

STUDY DESIGN: Single-group, repeated-measures design. OBJECTIVE: To compare patellofemoral joint kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella. BACKGROUND: The only previous study to quantify differences in patellofemoral joint kinematics during weight-bearing and non-weight-bearing tasks was limited in that static loading conditions were utilized. Differences in patellofemoral joint kinematics between weight-bearing and non-weight-bearing conditions have not been quantified during dynamic movement. METHODS AND MEASURES: Six females with a diagnosis of patellofemoral pain and lateral subluxation of the patella participated. Using kinematic magnetic resonance imaging, axial images of the patellofemoral joint were obtained as subjects extended their knee from 45 degrees to 0 degrees during non-weight-bearing (5% body weight resistance) and weight-bearing (unilateral squat) conditions. Measurements of patellofemoral joint relationships (medial/lateral patellar displacement and patellar tilt), as well as femur and patella rotations relative to an external reference system (ie, the image field of view), were obtained at 3 degrees increments during knee extension. RESULTS: During non-weight-bearing knee extension, lateral patellar displacement was more pronounced than during the weight-bearing condition between 30 degrees and 12 degrees of knee extension, with statistical significance being reached at 27 degrees, 24 degrees, and 21 degrees. No differences in lateral patellar tilt were observed between conditions (P = .065). During the weight-bearing condition, internal femoral rotation was significantly greater than during the non-weight-bearing condition as the knee extended from 18 degrees to 0 degrees. During the non-weight-bearing condition, the amount of lateral patellar rotation was significantly greater than during the weight-bearing condition throughout the range of motion tested. CONCLUSIONS: The results of this study demonstrated that lateral patellar displacement was more pronounced during non-weight-bearing knee extension compared to weight-bearing knee extension in persons with lateral patellar subluxation. In addition, the results of this investigation suggest that the patellofemoral joint kinematics during non-weight-bearing could be characterized as the patella rotating on the femur, while the patellofemoral joint kinematics during the weight-bearing condition could be characterized as the femur rotating underneath the patella.

Adolescent↗
PubMed1983

The vertical position of the patella.

A new radiographic method for estimation of the vertical position of the patella in extension is presented. The vertical position of the patella determined by this method and the length of the ligament, patella and its surface were all found to be related to body-height. The vertical position of the patella may thus be expressed as its ratio to body-height: the vertical index of the patella.

Adolescent↗
PubMed2002

The clinical history of mobile-bearing patella components in total knee arthroplasty.

Two hundred fifty-six primary cementless meniscal-bearing total knee arthroplasties were performed between May 1985 and January 1989. All knees were replaced with a low contact stress metal-backed anatomic mobile patella. The average patient follow-up was 11.5 years. No patellae were revised for failure of fixation and no dislocations or subluxations were reported. One patella was revised for polyethylene wear, and one well-functioning component was removed at the time of revision to facilitate range of motion and wound closure. The survival estimate at 12 years was 99.5%. Compared to the high incidence of failure of metal-backed fixed-bearing patellae components, the anatomic rotating patella provides durable long-term results with a low incidence of complications.

Adult↗
PubMedDate not supplied

Effect of estrogen replacement therapy on patella cartilage in healthy women.

OBJECTIVES: Patellofemoral osteoarthritis (OA) is a significant cause of morbidity. Epidemiological data suggests that the use of oestrogen replacement therapy (ERT) may protect against tibiofemoral knee OA. However, the effect on patellofemoral OA is unknown. The aim of this study was to test the hypothesis that long term ERT (greater than 5 years) is associated with increased patella cartilage in post menopausal women. METHODS: We studied 81 women (42 current users (> 5 yrs) of oestrogen replacement therapy and 39 never users). Articular cartilage volumes were determined by post-processing images acquired in the sagittal plane using a T1-weighted fat suppressed magnetic resonance sequence on an independent workstation. RESULTS: There was no difference in the amount of patella cartilage in women on ERT compared to women on no ERT. After adjusting for patella bone size, years since menopause, body mass index, age of menopause and smoking, ERT users had 2.07 +/- 0.76 ml of patella cartilage compared to 1.93 +/- 0.89 ml in non-users (P = 0.24 for difference). CONCLUSIONS: This study suggests that use of ERT for more than 5 years does not have a significant effect on patella cartilage, in contrast to the previously described effect on tibial cartilage. The reasons for this are unknown, but may indicate that there are differences in the mechanisms for development of knee OA at these sites.

Body Mass Index↗
PubMed2003

A correlative study between prevalence of chondromalacia patellae and sports injury in 4068 students.

OBJECTIVE: To study the prevalence of chondromalacia patella among college students and the correlation with sports injury. METHODS: 354 students from gymnastic department and 429 from nongymnastic department with knee joint pain were selected. 184 students from gymnastic department and 342 from nongymnastic department were checked randomly by a surgeon. 77 patients (37 males, 40 females) from gymnastic department and 119 patients (62 males, 57 females) from nongymnastic department were diagnosed as chondromalacia patellae. The amount of exercise and the occurrence of sports injury were investigated in each student. All data were analyzed with SPSS 10.0 statistical software. RESULTS: The prevalence of chondromalacia patella was 20.1% in female students and 11.6% in male students from gymnastic department, and 5.61% in female students and 4.92% in male students from nongymnastic department. The amount of exercise and the occurrence of sports injury to the knee joint in students from gymnastic department were greater than those from nongymnastic department. CONCLUSIONS: In both female and male students, the prevalence of chondromalacia patella is higher in gymnastic department than nongymnastic department. Sports injury is an important cause of chondromalacia patella.

Adolescent↗
PubMed2005

[Familial nail patella-syndrome].

Nail patella-syndrome is a rare hereditary (autosomal dominant) disorder resulting from a heterogenous loss of function in the LMXB1 gene on chromosome 9q34. It is associated with multiple deformities. Patients have a characteristic tetrad of pathologic symptoms including fingernail dysplasia, hypoplastic or absence patella, radial head dislocation, iliac horns and in some cases nephropathy and ophtalmo-logical findings (glaucoma). In this study four affected members in one family are presented. All of the familly members presented absence or hypoplastic patella and fingernails dysplasia. There were not indications for surgical treatment dislocated radial heads or subluxated dysplastic patella. Genetic counseling is recomended because nail patella syndrome is an autosomal dominant disease.

Adult↗
PubMed2006

[Comparison of three fixation methods in transverse fractures of the patella in a calf model].

OBJECTIVES: We evaluated the strength of three different fixation methods against distraction forces in a transverse fracture model of calf patellae. METHODS: Thirty calf patellae were randomly divided into three groups equal in number. Transverse fractures were induced at the same localization in all the samples. The fractures were fixed with a modified anterior tension band technique, Acutrak 4/5 screws, and a combination of Acutrak 4/5 screws and tension band technique in three groups, respectively. Following fixation, each patella was mounted in a compression-distraction testing machine from the quadriceps and patellar tendons on each side of the patella, and equal distraction forces were applied to each patella. The average load to failure at the fracture site was calculated and the results were compared with the Friedman test. RESULTS: The mean failure loads were significantly different in three groups, being 288.8+/-40.1 newton (N), 878.5+/-68.6 N, and 938.6+/-38.8 N, respectively (p<0.001). The most efficient stabilization was obtained in the third group in which Acutrak 4/5 screws and the tension band application were used in combination, while the modified anterior tension band technique alone was found to be the weakest fixation technique. CONCLUSION: Our results showed that Acutrak 4/5 screws enabled a rigid fixation in the surgical treatment of patellar fractures.

Animals↗
PubMedDate not supplied

The management of the patella in total knee arthroplasty.

Total knee arthroplasty (TKA) is a well-established procedure, and has proven to be durable and effective for the treatment of advanced arthritis of the knee joint. Early TKAs did not include patellar replacement and anterior knee pain was reported after the procedure had been carried out. The incorporation of patellar resurfacing during TKA reduces anterior knee pain, although new complications have emerged. These complications include component failure, instability, fracture, tendon rupture and soft tissue impingement. Such complications are attributed to inferior implant design and improper surgical techniques. Fear of sustaining these complications has prohibited surgeons from routine patellar resurfacing during TKA. Whether or not to resurface the patella during primary TKA is still a controversial topic. There are authors who recommend routine resurfacing, some who do not recommend resurfacing and some who suggest selective resurfacing. The rationale for and against patellar resurfacing during primary TKA has been individually justified and reported in the literature. The selection of suitable implants and adherence to proper surgical technique are the fundamental principles for the success of TKA. Patella resurfacing during TKA is recommended when inflammatory arthritis, an eburnated articular surface and patellofemoral maltracking are present; patella preservation is recommended when there is a small patella, normal articular surface and normal patellar tracking. In long-term follow-up, 60% of nonresurfaced patellas continued to have good tracking after TKA. The correct choice of patellar component size, as well as implant design, medial placement of the patellar component, rule of no thumb and lateral retinaculum release when needed, should be adhered to when performing patellar resurfacing during TKA.

Arthroplasty, Replacement, Knee↗
PubMed1991

[A case of idiopathic aseptic osteonecrosis of the patellae: repeat study of Tc-99m HMDP bone scintigraphy in a reparative phase].

A 37-year-old woman entered our hospital because of bilateral knee pain. Tc-99m HMDP bone scintigram demonstrated increased activity in the bilateral patellae and cold lesion in the center and left lateral segments of the left patellae, so-called doughnut pattern. Trephine biopsy was performed to prove bilateral idiopathic asepct osteonecrosis of the patellae. The knee pain subsided and a bone scan 5 months later demonstrated increased activity in the bilateral patellae more widely than initial scan. We report the usefulness of Tc-99m HMDP bone scintigraphy to observe a reparative phase of idiopathic asepct osteonecrosis of the patellae.

Adult↗
PubMed1991

The early diagnosis and treatment of developmental patella infera syndrome.

Developmental patella infera and associated arthrofibrosis after knee surgery require prompt recognition and treatment. The condition develops because of contracture of peripatellar tissues, fatpad tissues, and quadriceps weakness, and may rapidly progress to permanent patella infera and disabling patellofemoral arthrosis. Case studies for five patients with acute developmental patella infera are described. All patients required an early arthroscopic release of contracted tissues. To establish normal right to left patellar, vertical-height ratios, lateral roentgenograms were obtained in 202 normal knees (101 pairs). The data showed that although essentially no difference existed between right and left sides, large variations existed in the ratios from one individual to another (range, 0.75-1.46). Thus, the diagnosis of developmental patella infera requires comparison of patellar height ratios in the same knee or between knees in the same individual. A decrease in the vertical-height ratio of 11%-15%, depending on the method used, indicates developmental patella infera.

Adolescent↗
PubMed1991

[Patella partita in young athletes].

In 119 young athletes (116 boys and 3 girls), 171 patellae partitae were reviewed. The incidence of patella partita was 20% in boys and 2.2% in girls involved in athletics, being significantly higher (37.1%) in boys between 8 to 10 years of age than in older boys. According to the radiographic study, most cases of patella partita developed before the age of 12 years and the lesion could heal spontaneously in the patients under 13 years of age: the lesion healed in 83.9% of the patients who stopped playing sports, or played less strenuously, but in only 33.2% of those who continued playing as hard as before. From these results, patella partita is apparently caused by repeated stress on the marginal chondroosseous region of the developing patella and can heal spontaneously in growing children younger than 13 years in age.

Adolescent↗
PubMed1986

Normal blood supply of the canine patella.

The normal blood supply of the canine patella was evaluated, using microangiography and correlated histology. Arterioles entered the cortex of the patella at multiple sites along the medial, lateral, and dorsal aspects. The body of the patella was vascularized uniformly, with many arterioles that branched and anastomosed extensively throughout the patella. The patella was not dependent on a single nutrient artery for its afferent supply, but had an extensive interior vascular network. These factors should ensure rapid revascularization and healing of patellar fractures, provided appropriate fracture fixation is achieved.

Angiography↗
PubMed1985

Recurrent dislocation of the patella treated by the modified Roux-Goldthwait procedure. A prospective study of forty-seven knees.

We studied the results in forty-seven knees in thirty-seven patients - ten male and twenty-seven female - who had recurrent dislocation of the patella and were treated by a modified Roux-Goldthwait procedure (lateral retinacular release, medial transfer of the lateral patellar tendon without advancement, plication of the medial retinaculum, and advancement of the vastus medialis). Ten of the female patients had bilateral dislocation. The results were analyzed after follow-ups ranging from 3.0 to 16.3 years (average, 5.8 years). The study confirmed that a tangential radiograph of the patellofemoral joint, made with the knee in 20 degrees of flexion, is reliable in determining patellar displacement. The results were excellent in twelve knees, good in thirty-one, fair in one, and poor in three. The fair and poor ratings were due to pain caused by severe chondromalacia patellae. The patient with a fair result had had recurrent dislocations after the Roux-Goldthwait procedure due to a very lax synovial and capsular sac. Reoperation with tightening of the sac medially and laterally eliminated hypermobility of the patella in this patient and established straight patellar tracking. There was one serious complication, a large subcutaneous hematoma with necrosis of a skin flap. The patients with mild chondromalacia improved and showed no progressive patellofemoral arthritis after simple realignment, while those with severe chondromalacia were not improved by shaving, drilling, and realignment. Preliminary results indicated that a modified Maquet procedure, in addition to realignment, may be indicated for patients with severe chondromalacia. This study demonstrated that the modified Roux-Goldthwait procedure, without advancement of the tibial attachment of the patellar ligament, can stabilize the patella without increasing patellofemoral compression. The procedure does not relieve the symptoms of severe chondromalacia of the patella but realignment is the first step in treatment of any form of patellofemoral arthrosis.

Adolescent↗
PubMed1979

Chondromalacia and recurrent subluxation of the patella: a study of malalignment, with some indications for radiography.

The authors adopted four parameters in a study of 100 normal subjects and fifty patients affected by "chondromalacia" or by recurrent subluxation of the patella. These were: the quadriceps angle, the ratio between the length of the patellar tendon and the length of the patella, the femoral sulcus angle, and the congruence angle between the femur and patella. These parameters showed a statistically significant increase in the pathological group, thereby demonstrating that the majority of cases of "chondromalacia" of the patella and those of recurrent subluxation constitute two entities forming part of the same disease, the basis of which is malalignment and malposition of the patella.

Adolescent↗
PubMed1984

Current concepts of etiology and treatment of chondromalacia patellae.

Chondromalacia patellae is a distinct clinical entity characterized by retropatellar pain that is associated with recognizable changes in the articular cartilage of the posterior surface of the patella. Several factors may be involved in the etiology, such as severe patella alta, trauma, and, in rare cases, abnormal patellar tracking. Clinical symptoms and signs are reliable in only 50% of cases, but measurable quadriceps wasting, palpable patellofemoral crepitus, and effusion are strongly suggestive. Diagnosis must be confirmed by arthroscopy or direct examination of the posterior surface of the patella. Radiologic measurements of patellofemoral relations are of limited value in diagnosis. The initial pathologic finding is usually surface cartilage breakdown. Radioisotope studies show cartilage cell replication which suggests a healing capacity in early cases following treatment that alters the load through the affected cartilage. There is no evidence of progression to patellofemoral osteoarthritis, which is probably a different entity. The treatment should be conservative where possible with isometric quadriceps exercises and simple anti-inflammatory drugs such as aspirin. Operative treatment is indicated for patients with persistent pain and macroscopic involvement of more than half a centimeter of the articular cartilage surface. The simplest effective procedure that avoids quadriceps dysfunction and fibrosis is a distal patellar tendon medial realignment with lateral release and medial reefing of the quadriceps expansion. Patellectomy is indicated in more extensive involvement of the patella of 2 or more centimeters in diameter, but this must be performed only when the patient has excellent quadriceps function before surgery and is motivated to exercise after surgery.

Adolescent↗