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At least 37 records · Page 2Linked to original sources
PubMed1992

Patella alta and recurrent dislocation of the patella.

Fifteen knees were treated with a surgical technique designed for recurrent patellar dislocations when associated with patella alta. The average number of patellar dislocations preoperatively was 12, and the determination of patella alta was made using the technique described by Insall and Salvati, which is a ratio of the length of the patellar tendon to the longest diagonal length of the patella. The normal value for this ratio is 1.02 plus or minus 20%. The average preoperative ratio in this study was 1.58 (range, 1.2-2.1), which changed to 1.08 (range, 0.99-1.14) by the time of follow-up examination. The surgical technique used involves transposing the patellar tendon insertion distally without any medialization or recessing and allows for good bone contact for healing, secure fixation, and immediate postoperative motion. There were no recurrences of patellar dislocation postoperatively and few complications. Only one patient complained of anterior knee pain in the follow-up period. This technique is thought to give good results when it is used specifically for recurrent patellar dislocations associated with patella alta.

Adolescent↗
PubMed2003

Use of a trabecular metal patella for marked patella bone loss during revision total knee arthroplasty.

This study evaluates the short-term results following patellar resurfacing with a trabecular metal patella shell in the setting of marked patellar bone loss at the time of revision total knee arthroplasty (TKA). Twenty consecutive patients undergoing revision TKA with the use of a trabecular metal patella were evaluated at a mean 23-month follow-up. All patients had marked patellar bone loss at surgery precluding resurfacing with a standard cemented patellar button. Results were good or excellent in 17 of 20 patients. There were no displacements of any trabecular metal patella shells, and the fixation appeared excellent despite the poor quality of bone remaining. Complications included 3 patients with polar patella fractures postoperatively. Qualitatively, these results compare favorably with patellar resection arthroplasty in this setting.

Adult↗
PubMed1991

Effect of patella thickness on patella strain following total knee arthroplasty.

Patellar complications following total knee arthroplasty (TKA) have begun to emerge as a major cause of failure. In an effort to understand some of the mechanical factors that might contribute to patellar component failure, a biomechanical study was performed. Quadriceps force and anterior patellar strain were measured during dynamic flexion in 10 fresh, paired human cadaver knee joints. First, tests were performed in the intact knee, followed by either posterior cruciate ligament (PCL) retention or sacrifice of TKA without patellar resurfacing. Tests were then performed following patellar resurfacing with an overly thick, optimum and thin, bony patella. Patellar strain increased in each specimen (with flexion angles of up to 80 degrees), was most pronounced as the bony patella became thinner, was closest to the intact knee when the patella was not resurfaced, and was unaffected by PCL retention or sacrifice. Patellar osteotomy, resulting in a bony patellar thickness of less than 15 mm, resulted in significantly increased strain. TKA systems should include instrumentation that allows precise restoration of overall patellar thickness while maintaining a bony patellar thickness of at least 15 mm.

Cadaver↗
PubMed1997

Patella fractures associated with accelerated ACL rehabilitation in patients with autogenous patella tendon reconstructions.

Patella fracture is a recognized complication of ACL reconstruction with an autogenous patella tendon graft. Typically, fracture occurs as a result of a fall. The incidence of fracture is approximately 0.5%. Accelerated rehabilitation protocols can place stress on the patella, especially in the initial stages of recovery. Therapists are reminded to observe constraints placed on patients by biological tissues, recovering neuromuscular status, and previous level of conditioning. Rehabilitation protocols should be revised according to these factors.

Adult↗
PubMed1975

[Recentering the patella in the treatment of external femoropatellar arthrosis with displacement of the patella].

The authors report their experiences of the surgical treatment of external femoro-patellar arthrosis with displacement of the kneecap, by recentering the kneecap, on knees that were not deformed as seen from the front. This recentering of the kneecap, which was monitored during the operation by radiographs with axial projection, was obtained by internal transposition of anterior tibial tuberosity and section of the external " wing " of the patella. No inert or living material was placed between the patella and the trochlea. The reduction in pain and the improvement in articular function depend on how well the patella is recentered. Twenty-two cases of external femoro-patellar arthrosis with displacement of the kneecap were treated in this way; in 18 operations, 14 results that remained favourable for more than 6 months have encouraged the authors to continue their trials and to abandon, at least for the time being, patellectomies and patelloplasties.

Bone Nails↗
PubMed1988

Treatment of chondromalacia patellae by lateral retinacular release of the patella.

A series of 59 knees in 58 patients were surgically treated from 1977 to 1982 for chondromalacia patellae, and were followed for an average of 1.2 to 4.6 years after the operation. The operative procedure was open lateral retinacular release in all knees. In knees with recurrent patellar subluxation, the number of poor results increased from 24% to 70%, and in knees with no subluxation from 21% to 24%. The difference after 4.6 years was statistically significant. No correlation between the severity or location of the cartilage changes and the operative effect was found. Open lateral retinacular release is an acceptable treatment of chondromalacia patellae without subluxation of the patella, whereas in the presence of recurrent subluxation, the release does not correct the basic biomechanical disturbance.

Adolescent↗
PubMed1993

[Open lateral release of the patella combined with knife arthroscopy in the treatment of chondromalacia patellae].

Open lateral release of the patella, combined with knife arthroscopy was carried out unilaterally in 47 patients with chondromalacia patella, who had received systematic conservative treatments and not responded on it before this surgical procedure. The result of 18-month follow-up period showed that the excellent and good results were in more than 80% of the all patients. The authors felt that this procedure had the advantages of less traumatic damages, less complications, short period of the operation and hospitalization and rapid rehabilitation. In the paper it was also discussed on the significance of the lateral release for the treatment of chondromalacia patellae, its indications and the operation technique as well as the worth of the meanwhile performed knife arthroscopy in the treatment.

Adolescent↗
PubMed2004

Bilateral absence of the patella in nail-patella syndrome: delayed presentation with anterior knee instability.

A 27-year-old man, while serving in the armed forces, presented with complaints of right knee pain of 3 months duration. The patient reported pain localized on the lateral side of the right knee, especially during long-distance walking and stair climbing, and a feeling of giving way. There was no history of recent or remote trauma to the knee joint. At that time, he presented with knee pain and instability consistent with anterior cruciate ligament (ACL) insufficiency. During physical examination, the diagnosis of nail-patella syndrome (NPS) was made, but magnetic resonance imaging (MRI) of both knees revealed intact ACLs. The reported case presents NPS as a potential nontraumatic cause of anterior knee instability. In our patient, a discrepancy between the clinical and imaging findings was present. The initial clinical examination was consistent with ACL rupture or aplasia and this led to MRI evaluation of the knee, which showed an intact ACL, contrary to the initial diagnosis. It should be noted that anterior instability has been described after patellectomy and could be attributed to complete absence of the patella, which is rare in NPS.

Adult↗
PubMed1993

Cartilage degeneration in the human patellae and its relationship to the mineralisation of the underlying bone: a key to the understanding of chondromalacia patellae and femoropatellar arthrosis?

According to the literature subchondral bone plays a significant role in the transmission of load through joints and in the pathogenesis of osteoarthrosis. Therefore the degeneration of the articular cartilage was investigated in the patellae from 30 dissecting-room specimens and of 20 patients, previously submitted to arthroscopy, and subchondral mineralisation of their underlying bone was at the same time assessed by means of CT osteoabsorptiometry. Lateral cartilage lesions were localised over highly mineralised subchondral bone; these appear to be due to long-term stress. They were mainly found in the older specimens and showed a high rate of progression with increasing age. Medially localised cartilage lesions, on the other hand, were situated in a transitional region between moderate and slight subchondral mineralisation; they may be caused by infrequent stress peaks and by shear stress in the articular cartilage, the very medial part of the joint being deprived of mechanical stimulation for much of the time. These lesions were to be found predominantly in the younger specimens and showed little progress with advancing age. Patients with lateral cartilage degeneration exhibited higher, patients with medial chondromalacia patellae lower mineralisation than normals. Their density patterns therefore indicate a different mechanical pathogenesis of the cartilage lesions in the lateral and medial facet. It could be shown that CT osteoabsorptiometry allows an assessment of the mechanical situation, present in individual femoro-patellar joints, and that this situation is highly relevant for the pathogenesis of patellar cartilage degeneration.

Absorptiometry, Photon↗
PubMed2001

The patella in total knee replacement: does it matter? 750 LCS total knee replacements without resurfacing of the patella.

Hingelike moving total knee replacement (TKR) has shown that the "rotating" function of the quadriceps muscle becomes lost. Dynamic work of the vastus medialis is no longer needed, and the static part of the quadriceps muscle assumes the major part of the work, beginning with continuously dislocating the patella to the lateral side. We operated on 436 knees using the LCS (De Puy Orthopaedics, Warsaw, IN) meniscal bearing TKR. No primary patellar resurfacing was necessary in this series. The New Jersey Score increased constantly over the 5-year follow-up from 83 after 2 years to 90 after 5 years. This shows that there is no deterioration which can be attributed to a deterioration in the patellar behavior. Nonresurfacing of the patella is a possible solution if the kinematics of the TKR allow physiological rotation, the prosthesis is built anatomically, the alignment is correct, the anatomy of decelerator/extensor mechanism is respected by the approach, and ligamentous stability is good.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera.

Infrapatellar Contracture Syndrome (IPCS) is an infrequently recognized cause of posttraumatic knee morbidity. Unique to this group of patients is the combination of restricted knee extension and flexion associated with patella entrapment. IPCS can occur primarily as an exaggerated pathologic fibrous hyperplasia of the anterior soft tissues of the knee beyond that associated with normal healing. It can also occur secondarily to prolonged immobility and lack of extension associated with knee surgery, particularly intraarticular ACL reconstruction. IPCS follows a predictable natural history which is divided into three stages. Symptoms, diagnostic findings, and recommended treatment are determined by the stage at presentation. Once beyond its early presentation, IPCS is best treated by an anterior intraarticular and extraarticular capsular debridement and release, followed by extensive rehabilitation. The authors review 28 consecutive cases of IPCS. At followup 3 months to 4 years postoperation, the patients had averaged 2.3 additional surgical procedures following their index procedure or injury. The average increase in extension at followup was 12 degrees with the average increase flexion 35 degrees. Eighty percent of patients demonstrated signs and symptoms consistent with patellofemoral arthrosis; 16% of the patients demonstrated patella infera. The authors conclude that prevention or early detection and aggressive treatment are the only ways of avoiding complication in these problem cases.

Adolescent↗
PubMed1979

Proximal "tube" realignment of the patella for chondromalacia patellae.

In young people complaining of patellar pain there is often an anatomic basis (an increased quadriceps angle or a high-riding patella). Forty-eight knees with one or other of these abnormalities underwent proximal quadriceps realignment. The results were excellent or good in 94%. Shaving of chondromalacic cartilage was also done in 11 knees but did not seem to improve the results, and is not now recommended except for "blister" lesions. Extensor mechanism dysplasia is an etiologically correct name for the disorder and therefore preferable to "chondromalacia patellae."

Cartilage Diseases↗
PubMed1977

Heavy metal complexation in polluted molluscs. I. Limpets (Patella vulgata and Patella intermedia).

The accumulation of cadmium, zinc and copper by the marine gastropod molluscs Patella vulgata and Patella intermedia has been studied by gel permeation chromatography of water-soluble extracts of environmentally contaminated shellfish. A major proportion of the water-soluble cadmium and copper in these molluscs is associated with a protein of molecular weight 10 800 daltons. Evidence is presented supporting the similarity of this protein with mammalian metallothionein. This protein contained only a small proportion of the zinc found in the samples.

Amino Acids↗
PubMed1997

Small patella syndrome: a bone dysplasia to recognize and differentiate from the nail-patella syndrome.

We report a 5-year, 9-month-old boy with bilateral patellar hypoplasia. The radiographic skeletal survey revealed absent ossification of the ischium and inferior pubic ramus on both sides, characteristic of the newly recognized benign bone dysplasia known as small patella syndrome, or ischiopatellar dysplasia. No nail change, iliac horn, elbow anomaly, or renal disease is associated with this condition.

Bone Diseases, Developmental↗
PubMed2002

Osteochondrosis of the primary ossification center of the patella (Köhler's disease of the patella) report of three cases.

Radiography of three boys 5-6 years old with anterior knee pain revealed increased density and irregularity of the patellar ossification centers. A search of the literature suggested that it was osteochondrosis of the primary ossification center of the patella, named after Köhler. Continuing search also revealed that it might be a normal variant instead of an osteochondrosis. A short course of activity modification led to marked improvement in all. The patients were either asymptomatic or experienced minor symptoms 18-34 months after presentation. It was concluded that the process, either physiological or pathological, has a benign course and favorable prognosis.

Child↗
PubMed2001

The patella in total knee arthroplasty: resurfacing or nonresurfacing of patella.

Data from the Swedish Knee Arthroplasty Registry were analyzed to compare bi- and tricompartmental knee arthroplasties carried out in patients operated on for arthrosis in 1990-1996. Of the 16,607 primary arthroplasties that were carried out there were 5,139 with patellar replacement in the primary procedure and 10,928 without. By April 1998, 280 revisions were performed, 250 of these cases were analyzed in this study. Patella-related complications were commonly the reason for early revision: in 99 of the 168 knees with a primary bicompartmental procedure and in 36 of the 82 knees with a primary tricompartmental procedure. This presentation merely analyzes the extent of patellar problems in knee arthroplasty, as a detailed analysis of the causes of this common problem is not possible using data from a national multicenter study.

Arthroplasty, Replacement, Knee↗
PubMed1996

Management of patella fractures associated with central third bone-patella tendon-bone autograft ACL reconstructions.

Patella fractures are an acknowledged complication of cruciate ligament reconstructions that use bone-tendon-bone autografts. Two fracture patterns are seen: a nondisplaced longitudinal patellar fissure fracture recognized interoperatively and the classic displaced transverse fracture that disrupts the extensor mechanism. Rigid fixation techniques are described for each fracture type that minimally affect rehabilitative efforts.

Anterior Cruciate Ligament↗
PubMed1988

A comparative study of the extensor force of the quadriceps between subjects with a normal patella and those with patella alta of neurological pathogenesis.

The authors examined 20 subjects with infantile cerebral palsy, 10 of whom had patella alta, in order to evaluate any difference of extensor force of the quadriceps in the various degrees of flexion of the knee as compared with normal subjects. The objective was to reveal and measure any functional differences between the two groups.

Biomechanical Phenomena↗