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PubMed1996

Malignant lymphoma involving the patella.

The majority of skeletal lesions affecting the patella are benign and include entities such as chondroblastoma, giant cell tumor, osteomyelitis, and gout. Malignant processes involving the patella are distinctly unusual. Isolated occurrences of plasmacytoma, osteosarcoma, hemangiosarcoma, and metastatic disease have been reported. Malignant lymphoma involving the patella is extremely uncommon, although lymphomatous infiltration of the skeletal system is not a rare event, especially with the histiocytic lymphoma. The most frequent radiologic manifestations of skeletal lymphoma include osteolytic lesions with ill-defined margins involving the metaphysis of the long bones of the lower extremities. Involvement of the short tubular and flat bones, as well as the axial skeleton, occurs less commonly. The prognosis for lymphoma involving the skeleton is poor.

Aged↗
PubMed2002

Comparison of two total knee prostheses on the incidence of patella clunk syndrome.

The patella clunk syndrome is not an uncommon complication, particularly after posterior-stabilized (PS) total knee arthroplasty. The present study was a consecutive unselected series comparing the incidence of the patella clunk syndrome amongst two comparable groups of elderly patients with knee arthritis implanted with the Insall-Burstein (IB II) total knee system and the newer NexGen Legacy total knee prosthesis. While 7.5% of patients in the PS IB II group developed patella clunk syndrome, none occurred in the NexGen group (P=0.05). We believe the difference is due mainly to a change in the design of the prosthesis, especially the more posterior intercondylar box and femoral cam of the NexGen femoral component.

Aged↗
PubMed2002

[Ocular involvement in nail-patella syndrome (#161200)].

PURPOSE: The "nail-patella syndrome" (NPS) is an autosomal dominant hereditary systemic disease. The underlying defect of the LMX1B gene is localised on chromosome 9q34 and causes various typical clinical signs such as onychodysplasia, patella hypoplasia, renal involvement and open angle glaucoma. PATIENTS: A 42-year-old mother and her 4-year-old son were examined in our hospital in order to exclude ocular involvement in a genetically confirmed "nail-patella syndrome". A clinical examination including corneal topography, gonioscopy as well as measurement of intraocular pressure and bulbus length was performed. RESULTS: The examination of both patients showed NPS-specific symptoms, however the boy revealed no indications of glaucoma. He suffered from marked amblyopia caused by excessive astigmatism of the left eye and a bilateral moderate hyperopia. CONCLUSION: Because of the co-segregation between the syndrome and open angle glaucoma, NPS patients should undergo regular ophthalmological controls including measurement of intraocular pressure. Experiments on mice have shown that mutations of the LMX1B gene result in alterations of several structures of the anterior segments. Thus, the described refraction abnormality could be the consequence of structural changes at the corneal level due to NPS.

Adult↗
PubMed2003

Tuberculosis of the patella.

BACKGROUND: A rare case of patella tuberculosis in a 33-year-old man is presented. In the last two decades, tuberculosis has made a vigorous comeback, due mainly to large-scale migration of populations and the increasing number of immunosuppressed patients. Extrapulmonary tuberculosis accounts for less than 3% of cases, and sites like the patella are very rare. Fewer than 10 cases were found in the international literature. METHODS: A 33-year-old man presented in our department with a 9-month history of pain and swelling of the left knee. Tuberculosis of the patella was diagnosed after biological and radiological investigations. RESULTS: Imaging studies, especially MRI, are of great interest for the diagnosis and to assess the extent of tuberculosis. Histology of the curettage specimen is also required to reach a definitive diagnosis and develop an adapted management strategy (chemotherapy and rehabilitation). CONCLUSION: Diagnosis and treatment should be urgent, including surgical debridement and well-conducted antitubercular therapy to yield a satisfactory functional outcome.

Adult↗
PubMed2001

Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation.

The purpose of this study was to evaluate the significance of the Q angle with respect to the patella position. Fifty-six knee joints of 34 patients (15 bilateral) with chronic patellofemoral pain were prospectively evaluated. All patients were examined by the same orthopaedic surgeon (R.M.B.) and the Q angle measured clinically and using long radiographs. Additionally, axial computed tomography (CT) scans were obtained through the center of the patellar articular cartilage in 0 degrees of flexion. Three different patellofemoral indices were measured by the second author (K.W.), who was not involved in the clinical examination: lateral patellar displacement (LPD), lateral patellar tilt (LPT), and patella-lateral condyle index (PLCI). These results were compared with the values of the measured Q angle. For statistical analysis, the Pearson correlation coefficient was calculated and the Statistical Package for Social Science (SPSS) used. A pvalue < 0.05 was considered significant. We could not find a significant correlation between the Q angle values and the patellofemoral indices in all patients (bilateral or only right/left). Within the patients with bilateral patellofemoral pain (n = 15), there was a significant correlation between LPD and PLCI (p = 0.015), LPT and PLCI (p = 0.024) left and LPD and LPT(p = 0.011) right. Similar results were found in patients with pain only on one side. In conclusion, there is no significance between the Q angle and the position of patella. The diagnostic relevance of the Q angle could not be established.

Adolescent↗
PubMed1976

Goodpasture's syndrome in a patient with the Nail-Patella syndrome.

A patient with the nail-patella syndrome in whom end-stage renal failuure developed as the result of Goodpasture's syndrome is described. Lesions characteristic of both rare diseases were seen on renal morphology. It is postulated that the glomerular membrane alteration of the nail-patella syndrome predisposed to the development of antiglomerular basement membrane antibody and hence Goodpasture's syndrome. A review of the incidence of renal failure in the nail-patella syndrome suggests that renal involvement can no longer be regarded as benign and that immune mechanisms may be related to progressive renal disease in some cases.

Adolescent↗
PubMed1982

Marginal fractures of the patella.

Several types of marginal fracture of the patella are described together with the methods of treatment. The relationship between bipartite patellas and marginal fractures is also discussed. The diagnosis of marginal fracture of the patella should always be considered in cases of traumatic haemarthrosis of the knee so that appropriate radiographic examination can be made, followed by early treatment of the injury.

Adult↗
PubMed1995

Painful bipartite patella following injury.

We report nine rare cases of painful bipartite patella following injury to the knee, in seven non-athletic adults. Patients suffered with persistent anterior knee pain and localized tenderness over the superolateral aspect of the patella for an average of 2 years following injury. The clinical, radiographic and arthroscopic findings are described. Excision of the accessory bipartite fragment resulted in satisfactory relief of pain and complete restoration of the knee function in all patients at a mean follow-up of 10 months (range 3-36 months). Although painful bipartite patella may be considered rare it should be recognized as a cause of post-traumatic anterior pain in the adult.

Adult↗
PubMed1992

In vivo tracking of the human patella.

The purpose of this study was to describe the dynamic, in vivo, three-dimensional tracking pattern of the patella for one normal male subject. Intracortical pins were inserted into the patella, tibia, and femur. The subject performed seated and squatting knee flexion/extension, and maximum voluntary quadriceps contractions. In addition, the vastus medialis oblique was subjected to maximal electrical stimulation. Motions of the markers attached to the intracortical pins were analyzed using an automated video system. Patellar and tibial motions were determined relative to a femoral reference system. While the tibia flexed 50 degrees from full extension (seated condition), the patella flexed 30.3 degrees, tilted laterally 10.3 degrees, and shifted laterally 8.6 mm. In general, these results show qualitative agreement with the data collected from cadaveric specimens [van Kampen and Huiskes, J. orthop. Res. 8, 372-382 (1990)]. The differences present may reflect different passive constraints to patellar motions, and different relative loading of the individual quadriceps components, in our study compared to the cadaveric study. Only small differences were found between patellar motions in the seated and squatting conditions. Differences in patellar displacements produced by (1) maximal electrical stimulation of the vastus medialis oblique, and (2) maximum voluntary quadriceps contraction, at 30 degrees knee flexion and full extension, may reflect the dominant influence of passive constraints, and the vastus lateralis, on normal patellar motions. Further in vivo study of patellar tracking seems warranted to evaluate surgical and conservative interventions for patellofemoral disorders.

Adult↗
PubMed1992

Recurrent atraumatic superior dislocation of the patella: case report and review of the literature.

Recurrent atraumatic superior dislocation of the patella with spontaneous reduction prevented by interlocking osteophytes has not been previously reported. Eight previous case reports were noted in the literature with single episodes of interlocking by osteophytes in a superior dislocation, none with recurrence, and all treated by closed reduction. The presentation of a 60-year-old woman with recurrent atraumatic superior dislocation of the patella on three separate occasions required closed reduction due to interlocking patella and trochlear osteophytes that were preventing spontaneous reduction. Arthroscopic debridement of these osteophytes resulted in no functional limitation or recurrence of dislocation at 28-month follow-up. This case demonstrates successful arthroscopic treatment of this previously unreported condition. In light of the increasingly active aging population with coexistent patellofemoral joint osteoarthritis, this presentation may become more frequent.

Arthroscopy↗
PubMed2004

Radiographic changes in the patella following quadriceps turndown for revision total knee arthroplasty.

Quadriceps turndown is a technique that may be used to enhance exposure of the tight total knee arthroplasty (TKA), particularly in the revision scenario. This technique does, however, compromise the vascularity of the patella, with avascular necrosis (AVN) being a possible sequela. A modified Coonse-Adams quadriceps turndown was performed in 29 revision TKAs in 27 patients. Immediate preoperative and sequential postoperative radiographs were analyzed for changes in the patella, including sclerosis, flattening, fracture, and fragmentation, as evidence of possible AVN, and clinical scores were collected prospectively. Eight patellae had such radiographic changes. Despite a lack of corresponding worsening in clinical outcome in these patients, quadriceps turndown is shown to have a high risk of subsequent changes consistent with patellar AVN, and should be avoided when other available techniques can achieve satisfactory exposure.

Aged↗
PubMed2005

Arthroscopic findings in the knee in nail-patella syndrome: a case report.

Nail-patella syndrome is a rare genetic disorder that can cause significant morbidity in several organs, including the musculoskeletal system. This case report describes our arthroscopic findings in the knees of an adolescent with bilateral hypoplastic and subluxed patellae. Our findings suggest that early intervention should be considered whenever this syndrome is recognized. This may modify some of the long-term joint problems seen in adults with nail-patella syndrome.

Abnormalities, Multiple↗
PubMed2005

Arthroscopic excision of a painful bipartite patella fragment.

Bipartite patella, although usually asymptomatic, can become a source of persistent pain following injury. When nonoperative treatments such as physiotherapy and rest fail to produce any resolution in the symptoms, surgery is usually performed. This may include excision of the painful fragment, lateral retinacular release, or detachment of the vastus lateralis insertion, generally performed as open surgical procedures. In the case of vastus lateralis release, however, there has been recent report of statistically better results using an arthroscopic technique. Furthermore, open partial patellectomy has been criticized as being invasive and at times requiring long postoperative rehabilitation. We describe the case of a 26-year-old man who presented with a painful bipartite patella fragment that had not responded symptomatically to nonsurgical treatment. The painful fragment was removed arthroscopically as a day case under a general anesthetic. This was carried out through 3 portals and involved the use of a combination of probe, periosteal elevator, and arthroscopic shaver. Using this technique, we were able to minimize the surgical trauma associated with an open surgical procedure. The early result of this case encourages the use of an arthroscopic technique for partial patellectomy in the surgical treatment of a bipartite patella.

Adult↗
PubMed2005

Sex determination by discriminant analysis: an evaluation of the reliability of patella measurements.

Recently, a method which estimates the sex of unknown skeletal remains by discriminant function analysis of the patella has received much recognition. With seven simple measurements and a sexing accuracy of almost 84% this morphometric approach would be very suitable both in the forensic and anthropological context. In order to put this method to the test, 52 unfractured and non-pathological left and right patellae (26 males, 26 females) from a prehistoric skeletal sample were analyzed. In addition, 30 patellae were randomly selected which were not part of the original reference series. The first 15 (4 males, 11 females) had the same sample origin as the 30 target specimen but were of mediocre preservational state. The second 15 belonged to an archaeological sample of different provenience (8 males, 7 females). The results of the current study indicate that the morphometric assessment of this sesamoid is indeed well-suited as the results of the previous study could be duplicated, when sample size was not taken into consideration (85%). However, when the issue of small sample size was systematically addressed via a jack-knife procedure or the calculation of Delta-value, the resultant accuracies dropped to 78 and 74%, respectively. It is suggested that two confounding factors--age and sex of the individual--may be held accountable. There are slight, whilst not statistically significant tendencies to misclassify female and older specimen.

Anthropometry↗
PubMed2006

Retention of the patella in total knee arthroplasty for rheumatoid arthritis.

AIM: To determine whether retention of the native patella during total knee arthroplasty is appropriate in patients with rheumatoid arthritis. METHODS: All patients undergoing total knee arthroplasty with a diagnosis of rheumatoid arthritis were identified between January 1997 and December 2000. Subsequently, each individual underwent both radiological and clinical assessments at a designated follow-up clinic. RESULTS: A total of 30 total knee arthroplasties were studied in 28 patients. Twenty-six patients (93%) were female with a mean age of 74.7 years (range 60-83 years). The average post-operative interval was 59.4 months (range 46-82 months). All individuals were noted to have satisfactory patellar tracking and bone stock at the time of surgery. No patient subsequently underwent revision surgery during follow-up and no episodes of implant sepsis were identified. The mean Patellar Score at final follow-up was 26.2 (range 22-30) with an average anterior knee pain score of 14.2 (range 10-15). The mean Oxford Knee Score was 18.7 (range 16-23) with a mean pain score component of 5.9. Patients were finally assessed with respect to the Knee Society Score. The mean Knee Score was 83.8 (range 71-96) with a mean Function Score of 79.7 (range 40-90). CONCLUSION: By retaining the native patella we were still able to obtain highly satisfactory medium-term results in terms of pain relief and function. In addition, the potential complications associated with prosthetic replacement of the patella were avoided.

Aged↗
PubMed2004

T2 mapping: an efficient MR quantitative technique to evaluate spontaneous cartilage repair in rat patella.

OBJECTIVE: To evaluate the ability of T2 mapping on an 8.5 T imager to characterize morphologically and quantitatively spontaneous repair of rat patellar cartilage following full thickness defect. METHODS: Patellar cartilage defects were created in 24 rats knees on D0. Eight rats per time-point were killed on D20, D40 and D60 after surgery. T2 maps of repair tissue in patellar defects were obtained from eight different axial spin echo images on an 8.5 T imager. Global, superficial and deep T2 values were evaluated in spontaneous repair tissues (3x8 right patellae) vs the opposite patellae (3x8 left patellae) of the same animals. MR data were compared with macroscopic and histological studies. RESULTS: T2 map was able to identify morphologically three types of repair tissue observed macroscopically and histologically: 'total', 'partial' and 'hypertrophic' repair tissue. 'Total' and 'partial' repair tissues were characterized by global T2 values almost similar to controls, whereas 'hypertrophic' repair tissues were characterized by T2 global values higher than controls. Zonal variation between superficial and deep T2 values observed in controls was not depicted in repair tissue before D60. CONCLUSION: T2 map is able to characterize quantitatively and qualitatively rat patellar cartilage repair, and thus can be promoted, as a non invasive technique, in clinical longitudinal studies of articular cartilage repair.

Animals↗
PubMed2006

The patella morphology in trochlear dysplasia--a comparative MRI study.

BACKGROUND: Trochlear dysplasia is suspected to have a genetic basis and causes recurrent patellar instability due to insufficient anatomical geometry. Numerous studies about trochlear morphology and the optimal surgical treatment have been carried out, but no attention has been paid to the corresponding patellar morphology. PURPOSE: The aim of this study was the evaluation of the patellar morphology in normal and trochlear dysplastic knees. STUDY DESIGN: Biometric analysis. METHODS: Twenty two patellae with underlying trochlear dysplasia (study group--SG) were compared with 22 matched knees with normal trochlear shape (control group--CG) on transverse and sagittal MRI slices. We compared transverse diameter, cartilaginous thickness, Wiberg-index and -angle, length and radius of lateral and medial facet, patellar shape and angle, retropatellar length, and type of trochlear dysplasia. For statistical analysis we used the Wilcoxon signed ranks test. RESULTS: The transverse and sagittal diameter, mean length of medial patellar facet, and mean cartilaginous and subchondral Wiberg-index showed statistical differences between the two groups. CONCLUSIONS: Although the insufficient trochlear depth and decreased lateral trochlear slope are responsible for patellofemoral instability, the patella shows morphological changes in trochlear dysplastic knees. Its overall size and the medial facet are smaller. Although the femoral sulcus angle is larger, the Wiberg-angle and -index are equal to the control group. This may indicate that the patellar morphology may not be a result of missing medial patellofemoral pressure in trochlear dysplastic knees, but a decreased medial patellofemoral traction. This seems to be caused by hypotrophic medial patellofemoral restraints in combination with an increased lateral patellar tilt, both resulting in a decreased tension onto the medial patella facet. Whether there is a genetic component to the patellar morphology remains open.

Adolescent↗
PubMed2000

Fixation of patella fractures with braided polyester suture: a biomechanical study.

We tested the quality of fixation of displaced transverse patella fractures using braided polyester suture to investigate the suitability of this material as an alternative to stainless steel wire for fixation of these fractures. Osteotomies were created to simulate fractures of the patella in ten cadaveric knee specimens and were sequentially fixed using two techniques: the modified tension-band technique and the longitudinal anterior band (Lotke) technique. Each technique was implemented using either 1.25-mm stainless steel wire or 7-metric braided polyester suture (No. 5 Ethibond). The quality of fixation for each technique was tested by measuring the fracture gap during three simulated extensions of the knee against gravity on a materials testing machine. All techniques behaved comparably under the loading conditions used. In the four groups, there was no fixation failure (fracture gap > 3 mm) nor any significant difference between the mean maximum fracture gaps. The quality of fixation for braided polyester suture was comparable to that of stainless steel wire for such fractures, providing sufficient stability to withstand loads likely to be encountered during postoperative rehabilitation. Our results support the use of braided polyester suture as an alternative to stainless steel wire for fixation of displaced patella fractures.

Biomechanical Phenomena↗