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PubMed1980

[Traumatic chondropathia patellae, its significance for medical insurance in expert testimony concerning accident sequellae therapy].

The connection between chondropathia patellae and a trauma is discussed. Apart from direct traumas the indirect ones can also cause a chondropathia patellae as a result of the incongruence in the femoropatellar joint. In compiling the case history a preceding trauma of different forms and intensity can be found out in about 17 per cent out of all chondropathia patellae patients. When giving an expert's opinion on a case of chondromalacia sport and occupational lesions must be differentiated from genuine traumatic chondropathy. A chondropathia patellae is characterized by the above-mentioned patellar syndrome. The arthroscopy is considered the most reliable diagnostic method. The indication for operative treatment must take into consideration both the degree of the chondropathia patellae and the cause of the disorder.

Adolescent↗
PubMed1995

[A case of dislocation of a double patella].

The congenital dislocation of the patella is relatively rare and the duplicated patella associated is exceptional. The congenital character of the dislocation is unquestionable, but the etiology remains unknown. Before patellar ossification, the diagnosis is difficult and may be delayed for several years until progressive genu valgum, external tibial rotation and flexion deformity results. Radiographs are not useful in evaluating the dislocation until patellar ossification begins at approximately 4 years of age. CT scans and MR imaging reveal the diagnosis before patellar ossification and defines the magnitude of associated dysplasia and the presence of degenerative changes. Early treatment is recommended before the development of secondary bony deformity. We are reporting an unusual case of a woman with multiple epiphyseal dysplasia and bilateral congenital malformation of the patella (duplicated frontal type), associated with genu valgum and congenital dislocation of the patella. She was diagnosed at 31 years old. After surgical treatment (genu valgum correction by varus osteotomy, proximal and distal realignment of the extensor mechanism and osteosynthesis with screws of duplicated patella) and three years follow-up period, we have obtained a good result (painless knees, no recurrence of dislocation and active flexion of 100 degrees on the right knee and 120 degrees on the left knee).

Adult↗
PubMed1993

[Measuring intraosseous pressure and osseous venography of the patella in anterior knee pain. Part II].

"Anterior knee pain" is a rather meaningless term used for various forms of knee joint discomfort. Failure of venous drainage increasing intraosseous venous pressure is a cause that has hardly been considered hitherto. When exploratory surgery is performed to explain unknown anterior knee pain intraosseous venous pressure of the patella can be measured very easily during arthroscopy. Intraosseous venous pressure of the patella in patients with anterior knee pain was consistently documented higher than reported in the literature. There was a significant relationship between intraosseous venous pressure and number of veins. Intraarticular damage of cartilage did not correlate with intraosseous pressure. Drill holes in the patella reduced intraosseous pressure, as documented in an animal model. From June 1988 to October 1989 measurements and phlebographies of the patella were taken in 46 patients. Intraosseous venous pressure of 25 mmHg was considered normal. Among 46 patients treated with drill holes in the patella, six patients improved and had no symptoms following surgery. None of the patients was worse after surgery.

Adolescent↗
PubMedDate not supplied

Should total prosthetization of the patella be used in knee surgery? A review of the literature and personal experience.

Based on an analysis of patellar complications during total knee arthroplasty, the authors report the conclusions of the most important studies in the literature as to whether or not the patella should be prosthetized. In particular, several important parameters to be taken into consideration before performing patellar prosthetization are discussed: the conditions of the cartilage and of the patellar bone, preoperative clinical symptoms, age, habits, body weight of the patient. The results of 50 Miller-Galante prostheses implanted between January 1989 and September 1993 is reported. The patella was prosthetized in 40% of the cases; there were no fractures or vascular necroses, nor was there breakage or detachment of the prosthetic button. Patellar pain was manifested in 5 cases (10%), 2 of which with a prosthetized patella, including 1 case of external dislocation and 1 case of breakage of the patellar tendon; another case of external dislocation, in a non-prosthetized patella, was clinically asymptomatic; pain was manifested after delay in wound healing in 2 cases. Only one patient with breakage of the patellar tendon was submitted to further surgery. The authors conclude that in light of the numerous studies published prosthetization of the patella may offer overall better clinical results, but they advise that indications should be carefully evaluated for each individual case, and that details in surgical technique should be observed (correct execution of bone resection and of lateral release when necessary, preservation of Hoffa pad, accurate hemostasis).

Adult↗
PubMed2005

[Fixed posterior subluxation with lateral rotation of the knee joint caused by congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. Case report and review of the literature].

Congenital dislocation of the patella is very rare. In this anomaly, the patella is dislocated to the side of the lateral femoral condylus and cannot be repositioned manually. Diagnosis is often made by clinical examination and observation of an abnormal gait. We describe the long-term course of treatment in a young girl with fixed posterior subluxation with lateral rotation of the knee joint caused by congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. These anomalies of the knee joint were corrected incrementally. First, recentralization of the patella was performed by open surgery. Subsequently, distraction of the shortened ischiocrural muscles and the posterior capsules and ligaments was conducted. This is the first case to be described, to the best of our knowledge, of a patient with congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. We describe the successful treatment of such a fixed posterior subluxation and lateral rotation of the knee joint.

Child↗
PubMed2003

Natural history and pathogenesis of the patella clunk syndrome.

INTRODUCTION: The current study aims to test the importance of the design of total knee prostheses in the 'patella clunk syndrome', which is one of the possible patellofemoral complications that can occur after total knee replacement. MATERIALS AND METHODS: Three patient cohorts consisting of 75 consecutive patients with 80 Insall-Burstein II (IB II) total knee replacements; 57 patients with 60 Anatomic Modular Knee (AMK) total knee replacements; and 103 patients with 106 Low Contact Stress Rotating Platform (LCS) total knee replacements were studied during the period from 1995 to 2001. This was an unselected series of elderly patients with knee arthritis of comparable demographics; we excluded only those patients receiving revision surgery. We recorded the preoperative and postoperative Knee Society scores, and the patient subgroups with postoperative patellofemoral complications were analysed in detail and were serially followed up. Radiological analysis followed the recommendation of the Knee Society, and the degree of pain was recorded on a visual analogue scale. Also, since the majority of patients with patella clunk syndrome had refused operation and were followed up for several years, an idea of the natural history of this condition was obtained. RESULTS: The relative frequency of occurrence of patella clunk syndrome among patients with the IB II, AMK, and LCS prostheses was 8.8%, 3.3%, and 0%, respectively. The calculated p value is strongly significant when comparing the IB II group with the LCS group (p<0.01); and of borderline significance when comparing the AMK with the LCS group (p=0.05); and not statistically significant between the IB II and AMK groups (p=0.19). Analysis of the results also showed that about half of the patients who underwent conservative treatment still had incapacitating symptoms after several years of follow-up, while the other half showed progressive improvement over time. CONCLUSION: Given a good surgical technique in component placement and debridement of the peripatella synovium, the design of a total knee prosthesis has a strong bearing on the incidence of the patella clunk syndrome. The natural history of the patella clunk syndrome reveals that for as yet uncertain reasons about 50% will improve with time even when given conservative treatment.

Aged↗
PubMed1994

Innervation of the patella. An immunohistochemical study in mice.

In the mouse, arthritis was induced by a single sub-patellar intraarticular injection of bacterial collagenase. This procedure induces also patellar malalignment. A rich innervation of thin varicose calcitonin gene-related peptide (CGRP) and substance P (SP) immunoreactive fibers was found in the joint capsule, in the periosteum of the patella, in the synovial tissues at the lateral border of the patella, in the femoral groove, and in the subchondral bone of the patella and femur. Moreover, fibers were found in plica tissues between the quadriceps and patellar tendon, and the femoral groove. After the collagenase treatment, the general innervation pattern was comparable to that of the controls, but CGRP and SP innervation was no longer detectable with the antibodies in the plica tissues, and was to a lesser extent detectable in the fat pad of the patella, in the lateral borders of the patella and in the proliferated synovial tissues. Signs of degenerated axonal profiles were observed in these locations with a polyclonal antibody to the growth-associated protein GAP-43/B-50. At all the other peripheral locations, such as the muscles, the GAP-43/B-50 distribution was normal.

Animals↗
PubMed2000

[Surgical treatment of recurrent dislocation of the patella in children].

OBJECTIVE: To study an operative method for repair of recurrent dislocation of the patella in children. METHODS: 36 children with recurrent patellar dislocation were treated surgically at an average age of 9.1 years. They were followed on average for 4 years and 4 months. Nine of the 36 children underwent bilateral repair, with 45 knees were treated. The combined soft tissue operations included lateral retinacular releasing, medial retinacular tightening of the knee, vastus medialis muscle transfer to the patella, medial and distal transfer of the half patellar tendon. RESULTS: 28 patients had stable knee joint and a full range of motion, and improved sports activity after operation. Seven children achieved satisfactory function of the knee joint but there was no significant difference between pre-and postoperative sports exercise ability. One child suffered from a redislocation of the patella. Wound infection was not seen and the range of knee joint motion was not restricted in all patients. CONCLUSIONS: The combined procedures for repair of recurrent dislocation of the patella in children risk free for growth disturbances secondary to iatrogenic injury to the proximal tibial physis. It is safe and effective for recurrent dislocation of the patella in skeletally immature children.

Adolescent↗
PubMed2002

[Anterior transfer of the gracilis in repairing of recurrent dislocation and subluxation of the patella].

OBJECTIVE: To introduce anterior transfer of the gracilis in the treatment of recurrent subluxation and dislocation of the patella, and evaluate its effects. METHODS: Six patients with recurrent subluxation of the patella and 2 patients with postoperative recurrence of dislocation of the patella were treated with anterior transfer of the gracilis based on the lateral retinacular release and medial tightening. The efficacy was reviewed. RESULTS: The mean follow-up time was 22.4 months. No recurrence of subluxation of the kneecap occurred, and 7 cases had excellent results. CONCLUSION: Anterior transfer of the graciclis in repairing recurrent subluxation of the patella is easy to perform, and can effectively avoid the recurrence of subluxation of the patella.

Adult↗
PubMed2006

Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella.

Complications and results of medial patellofemoral ligament (MPFL) reconstruction, performed between 2000 and 2003, were studied retrospectively in 24 randomised patients (24 knees). All procedures were performed for recurrent dislocation or subluxation of the patella, using an autogenous semitendinosus tendon. Two different methods of anchoring of the transplant were compared. After a 2-year follow-up, patellar stability was found to be similar, when the transplant was sutured to the fibrous tissue and periosteum overlying the patella or when it was fixed in a bone tunnel through the patella. The majority of the patients who had undergone MPFL reconstruction have returned to their previous level of sports activities. We had two cases of patella fracture and one case of persisting patella apprehension after surgery. Further studies must determine which measures are necessary to prevent these complications.

Adolescent↗
PubMed1995

Small patella syndrome.

We report on 2 sporadic cases of small patella syndrome (coxo-podo-patellaire syndrome) most probably representing new mutations. Both children showed retarded patellar bone age (small patellae in Patient 1 and absent patellae in Patient 2) and pelvic abnormalities. Patient 1 who was fully investigated had an unusual facies with characteristic morphological abnormalities of the forefoot and generalized bone changes. Patient 2 was not available for examination and only X-ray films of his knees, pelvis, and chest were available. These were all abnormal. He was said to have an "unusual facies" with flattened nose and prominent forehead but no further information was available. We think that small patella syndrome (coxo-podo-patellaire syndrome) is a generalized bone dysplasia with morphological and diagnostic radiographic appearances.

Adolescent↗
PubMed2003

Autosomal recessive multiple epiphyseal dysplasia with homozygosity for C653S in the DTDST gene: double-layer patella as a reliable sign.

Mutations in the diastrophic dysplasia sulfate transporter (DTDST) gene result in a family of skeletal dysplasias, which comprise lethal (achondrogenesis type 1B and atelosteogenesis type 2) and non-lethal conditions (diastrophic dysplasia and recessive multiple epiphyseal dysplasia (rMED)). The most frequent mutation is R279W, which in a homozygous state results in rMED with bilateral clubfoot, MED, and "double layered" patella. We describe three patients with rMED caused by a previously unreported homozygous mutation in the DTDST gene. The three patients (from two families) were born to healthy, non-consanguineous parents. All developed signs of hip dysplasia in early childhood and two had episodes of recurrent patella dislocation. Two underwent bilateral total hip replacements at ages 13 and 14 years. The feet, external ears, and palate were normal. Stature was normal in all cases. Radiographs showed dysplastic femoral heads, mild generalized epiphyseal dysplasia, abnormal patella ossification, and normal hands and feet. Direct sequence analysis of genomic DNA demonstrated a homozygous 1984T > A (C653S) change in the DTDST gene in all patients. The clinically normal parents were heterozygous for the change. This is the first description of a homozygous C653S mutation of the DTDST gene. Hip dysplasia and patella hypermobility dominates the otherwise mild phenotype. These patients further expand the range of causative mutations in the DTD skeletal dysplasia family.

Adolescent↗
PubMed1984

Force ratios in the quadriceps tendon and ligamentum patellae.

We measured forces in the quadriceps tendon and ligamentum patellae in six human cadaver knee joints loaded through a range of flexion angles from 30 to 120 degrees. Using standardized loads based on one-sixth of maximum isometric quadriceps moments reported in human volunteers, we measured maximum average forces at 60 degrees flexion of 532 N in the quadriceps tendon (FQ) and 470 N in the ligamentum patellae (FL). Linear extrapolation to full maximum extensor moments results in estimates of 3,200 N for FQ and 2,800 N for FL. The force ratio (FL/FQ) reached a maximum value of 1.27 at 30 degrees and minimums of 0.7 at 90 and 120 degrees knee flexion. Contrary to prevailing opinion, our results indicate that the patella is not a simple pulley that serves only to change the direction of equal forces in the quadriceps tendon and ligamentum patellae. Instead, the ratio of forces in these structures varies significantly with flexion angle. The ratio appears to be determined by the changing location of the patellofemoral contact area relative to the insertions of the tendon and ligament. These findings emphasize the biomechanical importance of patellar length and of the vertical dimensions and locations of the patellofemoral contact area. Attempts at surgical intervention for the treatment of disorders of the extensor apparatus should recognize these variations. Procedures that tend to move the contact area more proximally (at a particular flexion angle) will also tend to decrease the FL/FQ ratio.

Aged↗
PubMed1994

Case report 858: Postradiation osteosarcoma of the patella.

A case of postradiation osteosarcoma of the patella in a 54-year-old man was presented. The lesion in the patella was diffuse and highly sclerotic, and was partially radiolucent in radiographs. The whole patella was removed by Miyakawa's method. Diagnostic criteria, clinical features, and radiographic findings of postradiation sarcoma were described. The rarity of osteosarcoma of the patella was emphasized.

Bone Neoplasms↗
PubMed1984

Radiology of postnatal skeletal development. X. Patella and tibial tuberosity.

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 two-thirds 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.

Adolescent↗
PubMed1997

Chondropathia patellae.

The articular surface of the patella and the contiguous articular surfaces of the femoral condyles are sometimes affected by disintegrational changes of the articular cartilage, which remain localized there for a longer period of time. In consideration of the pronounced functional impairment arising at marked changes of these articular surfaces, resection of the patellar surface, metallic resurfacing of the patella, periosteal resurfacing of the patella, or patellectomy have been described as treatment by various authors. Most of these modalities were followed by shortcomings of the results, as indicated in pertinent follow-up examinations and reports. Thus, a more physiological modality of treatment, organic resurfacing of the patella with synovial tissue, was applied in 7 patients and led to satisfactory results as ascertained by long-term follow-up examinations.

Adult↗
PubMed1986

Quantitation of glycosaminoglycan metabolism in anatomically intact articular cartilage of the mouse patella: in vitro and in vivo studies with 35S-sulfate, 3H-glucosamine, and 3H-acetate.

We investigated the usefulness of the whole mouse patella to quantitate the synthesis of the glycosaminoglycan (GAG) backbone and its sulfation by intact murine articular cartilage, both in vitro and in vivo. Using 35S-sulfate, 3H-glucosamine, or 3H-acetate as precursors of GAG synthesis, it was found that more than 90% of the incorporated radioactivity was confined to the patellar cartilage layer compared to the whole patella. Overnight papain digestion was enough to liberate more than 95% of the incorporated radiolabels, except for 3H-acetate for which 15-25% was not digestible. Comparison of radioactivity in the patella and that in quantitatively isolated GAGs revealed that for 35S-sulfate incorporation studies the whole patella can be used as a reliable measure for sulfated GAG synthesis. The situation was different for the GAG backbone precursors 3H-glucosamine and 3H-acetate; more than 50% of the 3H labels were incorporated into compounds other than GAGs or non-covalently associated with matrix components. Hence, in studying GAG-backbone metabolism, polysaccharides must be isolated quantitatively from cartilage. In vivo studies made it clear that both 35S-sulfate and 3H-glucosamine are incorporated into patellar GAGs in amounts high enough to enable proper quantitation and that the route of administration (intraperitoneally or intravenously) is of minor importance. Due to its low specificity for cartilage GAGs, 3H-acetate is not suitable for such studies.

Acetates↗
PubMed1994

Isolated or dominant lesions of the patella in gout: a report of seven patients.

Isolated or dominant osteolytic lesions of the patella are an unusual manifestation of gout. We present seven patients who had such patellar lesions unilaterally (six patients) or bilaterally (one patient) and analyze the radiologic characteristics to determine whether they can be differentiated from those of other osteolytic lesions of the patella. The lesions were uniformly characterized by a geographic pattern of bone destruction in the superolateral aspect of the patella. Five lesions were each accompanied by a peripatellar soft tissue mass, four of which contained calcification. It therefore appears that an osteolytic lesion of the superolateral portion of the patella, especially when associated with a peripatellar calcified soft tissue mass, should alert one to the possible diagnosis of gout. Awareness of this possibility may obviate the need for invasive diagnostic procedures.

Adult↗