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At least 253 records · Page 14Linked to original sources
PubMed1998

Patella fractures associated with injuries of the knee ligament.

Concurrent fractures of the patella and knee ligament ruptures are rare. From September 1985 to November 1989, 112 fractures of the patella were treated operatively at the Department of Traumatology at Celje General Hospital. In six patients (5%), associated badly injured ligaments of the knee joint were noted. During the operation, osteosynthesis of the patella was performed after the injured ligaments had been reconstructed. It is essential to examine the knee ligaments under general anesthesia before performing osteosynthesis of the patella. We have found no reports on this uncommon injury in the literature.

Adolescent↗
PubMed1995

The double patella syndrome.

First described by A. Trillat, the double patella is an uncommon clinical feature following repetitive injuries of the extensor mechanism of the knee. The first injury is a tendo-periosteal avulsion of the suprapatellar or, less frequently, infrapatellar tendon from the corresponding patellar pole. Often these avulsions are misdiagnosed and therefore treated only with a cast or no immobilization at all. Subsequent giving-way episodes lead to extensive ossification which is adjacent to or separated from the patella. The peculiar shape of this ossification overriding or underlying the primary kneecap justifies the denomination of double patella. Surgical treatment consists of removal of the calcification and reattachment of the tendon to the patella by transosseous sutures.

Adolescent↗
PubMed2005

[Avulsion fractures of the lower pole of the patella].

Fractures of the lower pole of the patella are rare and occur typically in children. In these types of fractures an extensive sleeve of cartilage is pulled off with a small bony fragment. The so-called sleeve fractures are often overlooked in plain radiographs. We describe the operative treatment and outcomes in two patients with sleeve fractures, one receiving early and one delayed treatment.A 12-year-old boy (case 1) sustained an indirect injury to the left knee while playing ball. Clinical examination showed a lag of active extension of the left knee without decrease in passive range of motion. At 9 years of age, a 12-year-old girl (case 2) sustained a direct blunt trauma to her right knee while playing ball. The lesion of the lower pole of the patella was not diagnosed in time. During the following 3 years a lag of extension of the right knee developed.The sleeve fracture diagnosed early was treated by open reduction and internal fixation with transosseous suturing. At the 6-month follow-up the knee had regained full range of motion. The sleeve fracture diagnosed late showed a nonunion of the patella resulting in a lag of extension. Even after 3 years a shortening osteotomy of the patella resulted in full range of motion of the right knee.

Arthroplasty, Replacement, Knee↗
PubMed2001

[Medial patella dislocation].

A patellar dislocation is usually understood to mean a lateral dislocation of the patella. Medial patellar dislocations have mainly been described after surgical treatment, such as release of the lateral retinaculum. Here a case of medial patellar dislocation is reported which did not occur subsequent to surgery. Wilberg-III patella, genu recurvatum with patella alta and a m. vastus medialis insertion widely distal to the patella were predisposing factors.

Adolescent↗
PubMed1999

Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts.

We report a prospective series evaluating the incidence and degree of tunnel widening in a well-matched series of patients receiving a hamstring or patella tendon graft for anterior cruciate ligament (ACL) deficiency. We correlated tunnel widening with clinical factors, knee scores, KT-1000 and isokinetic muscle strength to determine the clinical significance of this finding. Seventy-three patients at least 12 months post-ACL reconstruction were evaluated. Thirty-eight patients had received a doubled semitendinous and gracilis graft and 35 a bone-patella tendon-bone graft. All patients underwent a similar endoscopic procedure and accelerated postoperative rehabilitation. Tunnel widening was determined using standardized anteroposterior (AP) and lateral X-rays adjusted for magnification. A limited series of MRIs was performed to validate these measurements. There was a significant difference in the degree of tunnel widening between the two groups. The mean increase in femoral tunnel area in the hamstring group was 100.4% compared with a decrease of 25% in the patella tendon group (P = < 0.0001). In the tibial tunnel the mean increase in the hamstring group was 73.9% compared with a decrease of 2.1% in the patella tendon group (P = < 0.0001). The MRIs validated the plain film measurements. Tunnel widening did not correlate with the clinical findings, knee scores, KT-1000 or isokinetic muscle strength. Tunnel widening is marked in the hamstring group. Tunnel widening does not correlate with instability or a poor clinical outcome in the short term. The long-term implications of this finding are still to be determined.

Adult↗
PubMed1999

Superior results with continuous passive motion compared to active motion after periosteal transplantation. A retrospective study of human patella cartilage defect treatment.

Fifty-seven consecutive patients (33 men and 24 women), with a mean age of 32 years (range 16-53 years), who suffered from an isolated full-thickness cartilage defect of the patella and disabling knee pain of long duration, were treated by autologous periosteal transplantation to the cartilage defect. The first 38 consecutive patients (group A) were postoperatively treated with continuous passive motion (CPM), and the next 19 consecutive patients (group B) were treated with active motion for the first 5 days postoperatively. In both groups, the initial regimens were followed by active motion, slowly progressive strength training, and slowly progressive weight bearing. In group A, after a mean follow-up of 51 months (range 33-92 months), 29 patients (76%) were graded as excellent or good, 7 patients (19%) were graded as fair, and 2 patients (5%) were graded as poor. In group B, after a mean follow-up of 21 months (range 14-28 months), 10 patients (53%) were graded as excellent or good, 6 patients (32%) were graded as fair, and 3 patients (15%) were graded as poor. Altogether, nine of the fair or poor cases (50%) were diagnosed with chondromalacia of the patella. Our results, after performing autologous periosteal transplantation in patients with full-thickness cartilage defects of the patella and disabling knee pain, are good if CPM is used postoperatively. The clinical results using active motion postoperatively are not acceptable, especially not in patients with chondromalacia of the patella.

Adult↗
PubMed1996

Patella alta in southern China. A new method of measurement.

The position of the patella in the Southern Chinese population is 15 to 20% higher than in Western populations, both in controls and in disease. Those with patellar dislocation and anterior knee pain have significantly higher patellae than the controls in both population groups, and this is confirmed in the 5 methods of measurement we have studied. Patella alta is more common in our region. The patella alta index described in this paper provides a reliable and reproducible measurement of patellar height. A value of more than 3.4 is abnormal in our population.

Adolescent↗
PubMed1994

Lateral release in chondromalacia patellae using clinical, radiologic, electromyographic, and muscle force testing evaluation.

Lateral release (division of the lateral retinaculum of the patella) is a common operative procedure to improve alignment of the patella in patients with chondromalacia patellae. We investigated the effects of lateral release using clinical follow-up and studied the changes in the radiologic measurements of the patellar alignment and electromyographic function of the stabilizing muscles of the knee, as well as using muscle-force tests of the thigh. The study included 75 patients. Diagnostic arthroscopy was done for all patients. In 42 patients with obvious incongruency of the patellofemoral joint observed at arthroscopy, open division of the lateral patellar retinaculum was performed in addition to arthroscopy. Four years after surgery, the results showed that although division of the lateral retinaculum of the patella reduced lateral patellar tilting and lateral patellar displacement, the postoperative physical capacity of the patients was not improved. Lateral release did not impair the electrical activity of thigh muscles. The Lysholm scores of the lateral release group and the control group were equal after four years.

Adult↗
PubMedDate not supplied

The height of the patella: an anatomical study.

The anterior region of the left knee joint of fifty fresh human cadavers (37 males, 13 females) was dissected and the following measurements were carried out: length of the patella (LP), width of the patella (WP), length of the patellar tendon (LT), and width of the patellar tendon (WT). The ratio LT/LP for assessment of the vertical position of the patella was 1.00 (range 0.72-1.38; SD 0.14) and found to be in full agreement with radiographic studies carried out first by Insall and Salvati in 1971 and later by other authors. There was no significant statistical difference between the Insall-Salvati index in males and females. The length and width of the patella as well as the length of the patellar tendon were found to be significantly larger in males than in females (P less than 0.001).

Adolescent↗
PubMed1995

[Familial association of penoscrotal transposition and diphallia (double penis) with patella aplasia].

BACKGROUND: Diphallia and penoscrotal transposition are rare, generally sporadic, abnormalities. CASE REPORTS: Case 1: A 2-1/2-month-old boy was admitted in hospital because he suffered from complete penoscrotal transposition, with moderate hypospadias for which he was operated on. Examination at the age of 6 years showed hypoplastic and dislocated patellae. Case 2: A 2-month-old boy, brother of case 1, also suffered from incomplete penoscrotal transposition, associated with diphallia but without double bladder, that was operated on. Ultrasonography at the age of 17 months showed absence of patellae. The sister of these two patients was normal but her mother displayed ambiguous genitalia with phallic structure located beneath partially fused labial folds. Her patellae were also absent. CONCLUSION: This is the first familial case of true diphallia associated to penoscrotal transposition. This abnormality is also associated to absence of patellae and seems to be dominantly inherited.

Abnormalities, Multiple↗
PubMed2005

Influence of the pneumatic tourniquet on patella tracking in total knee arthroplasty: a prospective randomized study in 100 patients.

One hundred consecutive patients with osteoarthritis of the knee joint and scheduled for primary total knee arthroplasty performed in a bloodless field were prospectively randomized to have the tourniquet inflated on either straight leg or maximally flexed knee. There was no difference in the number of lateral releases between the groups, and position of the knee in maximal flexion during inflation of the tourniquet did not decrease the number of lateral releases. There was no difference in clinical or radiological patella tracking between groups. If the patella was maltracking, tourniquet deflation led to better patella tracking and saved 5 (31%) of 16 releases with no difference between groups. We recommend tourniquet deflation and reevaluation of patella tracking before performing lateral release in patellar maltracking.

Adult↗
PubMed2006

Effect modification by delta-aminolevulinic acid dehydratase, vitamin D receptor, and nitric oxide synthase gene polymorphisms on associations between patella lead and renal function in lead workers.

Genetic polymorphisms that affect lead toxicokinetics or toxicodynamics may be important modifiers of risk for adverse outcomes in lead-exposed populations. We recently reported associations between higher patella lead, which is hypothesized to represent a lead pool that is both bioavailable and cumulative, and adverse renal outcomes in current and former Korean lead workers. In the present study, we assessed effect modification by polymorphisms in the genes encoding for delta-aminolevulinic acid dehydratase (ALAD), the vitamin D receptor (VDR), and endothelial nitric oxide synthase on those associations. Similar analyses were conducted with three other lead biomarkers. Renal function was assessed via blood urea nitrogen, serum creatinine, measured and calculated creatinine clearances, urinary N-acetyl-beta-D-glucosaminidase, and retinol-binding protein. Mean (SD) blood, patella, tibia, and dimercaptosuccinic acid-chelatable lead values were 30.9 (16.7) microg/dl, 75.1 (101.1)and 33.6 (43.4) microg Pb/g bone mineral, and 0.63 (0.75) microg Pb/mg creatinine, respectively, in 647 lead workers. Little evidence of effect modification by genotype on associations between patella lead and renal outcomes was observed. The VDR polymorphism did modify associations between the other lead biomarkers and the serum creatinine and calculated creatinine clearance. Higher lead dose was associated with worse renal function in participants with the variant B allele. Models in two groups, dichotomized by median age, showed that this effect was present in the younger half of the population. Limited evidence of effect modification by ALAD genotype was observed; higher blood lead levels were associated with higher calculated creatinine clearance among participants with the ALAD(1-2) genotype. In conclusion, VDR and/or ALAD genotypes modified associations between all the lead biomarkers, except patella lead, and the renal outcomes.

Acetylglucosaminidase↗
PubMed2005

The effect of patella taping on vastus medialis oblique and vastus laterialis EMG activity and knee kinematic variables during stair descent.

The purpose of this study was to evaluate the effect of patella taping in normal subjects. Previous work has established positive effects of patella taping on patellofemoral pain syndrome patients, but the mode of action remains unclear. It has been hypothesized that taping brings about subtle changes in the internal physiological environment of the joint. It could be expected that in normal joints taping would bring about a measurable change in function, as the joint is no longer operating in an optimal physiological environment. 10 normal female subject's (21.4+/-1.2 years) vastus medialis oblique (VMO) and vastus laterialis (VL) EMG activity and knee kinematics (peak stance flexion angle and angular velocity) were assessed during a step descent, with and without a taped patella. The effect of taping was to significantly decrease VMO and VL EMG activity. Taping also significantly reduced peak stance phase knee flexion and peak stance phase knee flexion angular velocity. In normal asymptomatic subjects patella taping created a situation in which their performance was changed to one similar to that of the pathological patellofemoral pain syndrome population. It would appear that taping caused the joint to function sub-optimally supporting the hypothesis that taping could change the functioning of the patellofemoral joint.

Adaptation, Physiological↗
PubMed2006

Histopathological abnormalities in painful bipartite patellae in adolescents.

The purpose of this study was to clarify the etiology of painful bipartite patella in adolescents by histopathological examination of excised specimens. We performed excision of a fragment of painful bipartite or tripartite patella from six patients (six knees). The articular cartilage, interposed tissue, bone, and bone marrow of the excised specimens were histologically examined. The articular cartilage was intact in all but two patellae. The predominant composition of the interposed tissue was fibrous tissue in one patient; fibrous tissue and fibrocartilage in four patients; and fibrous tissue, fibrocartilage, and hyaline cartilage in one patient. In the interposed tissue, diffuse degenerative and necrotic fibrocartilage was observed in four patients and focal necrotic fibrocartilage was seen in two patients. In all patients, the central region of the interposed tissue almost completely lacked blood vessels. Other histological features of the interposed tissue included necrosis of the trabecular bone in three patients, irregularly shaped spicules of immature bone in three patients, and fragments of hyaline cartilage in two patients. In all patients the bone marrow adjacent to the interposed tissue showed numerous small blood vessels, and trabecular bone surfaces and the fibrocartilage surface adjacent to this bone marrow was scalloped and lined with numerous osteoclasts. The striking histopathological features of the interposed tissue were fibrous tissue and necrosis of the fibrocartilage. These abnormalities may ultimately lead to the failure of an accessory ossification center to unite with the main portion of the patella.

Adolescent↗
PubMed1993

Apparent velocity of ultrasound (AVU) at the patella in comparison to bone mineral density at the lumbar spine in normal males and females.

It has been reported that apparent velocity of ultrasound (AVU) at the patella discriminates as well between osteoporotic and normal subjects as measurement of bone mineral density (BMD) using dual photon absorptiometry. To investigate the relationship between AVU and peak bone mass, we compared AVU (Signet, Osteo-Technology, Framingham, MA) at the patella and BMD (QDR 1000, Hologic, Waltham, MA) at the lumbar spine in a large sample of healthy males and females. The study population consisted of 153 males (aged 20-60 years) and 129 premenopausal females (aged 20-52 years). Vertebral BMD showed no significant difference between males and females (1.03 +/- 0.16 g/cm2 for males vs. 1.07 +/- 0.14 g/cm2 for females, NS), while AVU values were significantly higher in males compared with females (1967 +/- 64 m/s vs. 1938 +/- 76 m/s, P < 0.05). In men there was a significant decrease in BMD with aging (r = -0.27, P < 0.05), in premenopausal females we found no age-related change in BMD. Similarly in males AVU decreased significantly with age (r = -0.2, P < 0.05), whereas in females AVU values showed relative stability over the age range. There was a significant correlation between AVU and BMD (r = 0.36 for males, r = 0.34 for females, P < 0.05). Our study demonstrates only a weak correlation between AVU at that patella and BMD at the lumbar spine, supporting the view that AVU not only reflects bone quantity but possibly also qualitative properties of bone structure. The sex difference in AVU but not in BMD suggests that the trabecular bone at the patella differs significantly from axial trabecular bone. The identical peak BMD at the lumbar spine for young males and females underscores the importance of the menopause for later manifestation of vertebral fractures.

Absorptiometry, Photon↗
PubMed2003

Quantitative measurement of patellofemoral joint stability: force-displacement behavior of the human patella in vitro.

Patellofemoral joint instability is a common clinical problem. However, little quantitative data are available describing the stability characteristics of this joint. We measured the stability of the patella against both lateral and medial displacements across a range of knee flexion angles while the quadriceps were loaded physiologically. For eight fresh-frozen knee specimens a materials testing machine was used to displace the patella 10 mm laterally and 10 mm medially while measuring the required force, with 175 N quadriceps tension. The patella was connected via a ball-bearing patellar mounting 10 mm deep to the anterior surface to allow natural tilt and other rotations. Patellar force-displacement behavior was tested at flexion angles of 0 degrees, 10 degrees, 20 degrees, 30 degrees, 45 degrees, 60 degrees, and 90 degrees. Significant differences were found between the lateral and medial restraining forces at 10 mm displacement. For lateral displacement, the restraining force was least at 20 degrees of knee flexion (74 N at 10 mm displacement), rising to 125 N at 0 degrees and 90 degrees of knee flexion. The restraining force increased progressively with knee flexion for medial patellar displacement, from 147 N at 0 degrees to 238 N at 90 degrees. With quadriceps tension, the patella was more resistant to medial than lateral displacement. Our finding that lateral patellar displacement occurred at the lowest restraining force when the knee was flexed 20 degrees agrees with clinical experience of patellar instability.

Aged↗
PubMedDate not supplied

Anterior cruciate ligament injury and patella dislocation: a report of nine cases.

Nine patients had combined anterior cruciate ligament (ACL) disruption and patella dislocation and underwent surgical reconstruction of one or both of these injuries. Six patients had both the ACL reconstructed and the patella realigned, and three had only the ACL reconstructed. Associated injuries were present in eight cases; these included meniscal tears in eight patients and medial collateral ligament injuries in two of these same patients. At final follow-up, at an average 19.7 months, examination revealed an average grade 1A Lachman and no pivot on all patients who underwent ACL reconstruction. No patients had hypermobile patellae or apprehension. One patient had a 4 degrees loss of extension and none had a loss of flexion. Two patients had continued anterior knee pain at final follow-up; one of these patients was the same person who had a loss of extension. None had recurrent instability of the ACL and none had recurrent instability of the patella.

Adolescent↗
PubMed1987

The relationship of lateral releases to patella viability in total knee arthroplasty.

A prospective clinical and radionuclide study was done to ascertain the effect of a lateral release on patella vascularity in total knee arthroplasty. Although the basic surgical procedure was the same in all 36 knees, postoperative technetium bone scans revealed a higher incidence (9 of 16, 56.4%) of vascular compromise in knees with a lateral release than in those without a lateral release (3 of 20, 15%). Although only one clinical complication (fractured patella not requiring secondary surgery) occurred, the lateral release itself appears to have a causal relationship with patella viability. It does not seem to be the sole determinant, however, because the development of a "cold" patella in three knees that did not have a lateral release implicates other factors, such as thermal necrosis and anatomic variation of the blood supply.

Aged↗