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PubMed2006

[The evaluation of patients undergoing total knee arthroplasty with or without patellar resurfacing].

OBJECTIVES: We evaluated the clinical and radiographic results of total knee arthroplasty (TKA) with or without patellar resurfacing. METHODS: The study included 149 knees of 126 patients who underwent TKA for primary knee osteoarthritis with (59 knees, group 1) or without (90 knees, group 2) patellar resurfacing. Clinical evaluations were made with the knee and function scores of the Knee Society, and patella scoring system; radiographic evaluations included changes in the joint line, Insall-Salvati ratio, lateral patellofemoral angle, and congruency angle. The mean follow-up period was 66.7 months (range 34 to 123 months) in group 1, and 68.1 months (range 30 to 117 months) in group 2. RESULTS: Although postoperative knee and function scores showed significant improvements in both groups (p<0.001), these did not reach significance between the two groups (p>0.05). The mean patella scores did not differ significantly, either (p>0.05). Postoperative radiographic assessments did not show significant differences between the two groups with respect to mechanical axis values, patellar tilt, and lateral subluxation (p>0.05). Symptomatic patellar subluxation, dislocation, fracture or rupture of the extensor mechanism did not occur in any of the treatment groups. None of the patients required revision associated with the patella and patellar prosthesis. CONCLUSION: Our findings suggest that patellar resurfacing is not necessary other than patients with significant degeneration of the patellar surface.

Adult↗
PubMed2005

[Patella dislocation].

Patella dislocation is a classical injury affecting teenagers. In 2/3 of cases, it occurs in sports activities. It is often a benign trauma which happens in a patello-femoral dysplasia context, leading to dislocation and reccurence if nothing is done to correct the defaults. Radiographic and scanner examinations allow to measure the dysplasia parameters and think about its correction. With MRI documentation, capsulo-ligamentous and cartilaginous lesions can be identified and their surgical repair can be discussed. When the dislocation occurs in a normal anatomical context, conservative therapy is still indicated.

Adolescent↗
PubMed2005

Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation.

We report on a series of 7 patients who presented with patella dislocation and were found to have osteochondral fracture (OCF) of the weight-bearing portion of the lateral femoral condyle either through preoperative studies or by identification of the lesion during arthroscopy. Treatments included open reduction and internal fixation, debridement, and microfracture of the lateral femoral condyle. Although not as common as osteochondral injuries to the medial facet of the patella and the anterior lateral portion of the lateral femoral condyle, osteochondral injury to the weight-bearing portion of the mid-lateral femoral condyle does occur with patella dislocation and was recognized in these 7 patients. The surgeon who treats known patellofemoral dislocations should be aware of this uncommon lesion to ensure detection and appropriate treatment. Also, in the case of uncertainty about the mechanism of injury, recognition of this lesion should heighten suspicion of patellofemoral dislocation.

Adolescent↗
PubMed2005

Non traumatic dislocation of the patella in children: the case for a dysplastic aetiology.

Congenital dislocation of the patella may be a phenotype, which has several genotypes, i.e. it may be congenital or acquired. This hypothesis is suggested with three illustrative case studies. Risk factors predictive of the development of irreducible dislocation of the patella in infancy are suggested. As there is a spectrum of possible aetiologies, 'late' diagnosis and a number of 'risk' factors but a common pathology, the word 'congenital' is not always appropriate. We suggest 'Developmental dysplasia and dislocation of the patella (DDDP)' is a more appropriate term for this rare condition.

Child, Preschool↗
PubMed2006

Spontaneous patella dislocation in Rubinstein Taybi Syndrome.

A patient with Rubinstein Taybi Syndrome ( RTS) was found to have spontaneous patella dislocation and spontaneous patella reduction. Clinical examination revealed ligamentous laxity and reducible patella. Open reduction and stabilization with semitendinosus tenodesis were done. Surgical treatment should not be put off because of the delay in the ability to walk in addition to the poor psychomotor abilities of children with RTS. This case is of particular interest as it represents an unusual type of dislocation that has not been reported in the literature so far.

Child, Preschool↗
PubMed2004

The management of superior dislocation of the patella with interlocking osteophytes--an update on a rare problem.

The superior dislocation of the patella with interlocking osteophytes is a rare condition. A review of the English literature revealed only 12 reported cases. The purpose of reviewing these case reports is to highlight the unusual presentation and the injury mechanism in 2 of our patients, and to present our treatment algorithm. Closed reduction with manipulation of the patella, with or without anaesthesia, was performed without difficulty. We recommend an intermediate step of trying a regional nerve block before proceeding to general anaesthesia. Our patients had full range-of-motion after reduction and they were symptom-free after 3 years of follow-up. There were no recurrent dislocations in our patients.

Aged↗
PubMed2000

The influence of weakness in the vastus medialis oblique muscle on the patellofemoral joint: an in vitro biomechanical study.

OBJECTIVE: Investigation of the influence of weakness in the vastus medialis oblique muscle on patellar tracking. DESIGN: In vitro biomechanical study. BACKGROUND: Currently, the influence of weakness in the vastus medialis oblique muscle on patellar tracking has not been well understood. METHODS: Seven human cadaveric knees were used. The direction of loading forces in the rectus femoris/vastus intermedius, vastus medialis oblique, and the vastus lateralis muscles was decided by the muscle alignment of each cadaver knee measured at the time of dissection. The loads used were 60 N in the rectus femoris, 50 N in the vastus lateralis, and 40 N in the vastus medialis oblique, according to the ratio calculated from the cross-sectional study. The weakness of vastus medialis oblique was simulated at 30 N (75%), 20 N (50%), 10 N (25%), and 0 N (0%), and the patellar position was measured for each condition using a magnetic 3 Space Tracker System. The influence of weakness in the vastus medialis oblique muscle on patellar position was investigated with seven cadaver knees using a magnetic 3 Space Tracker System. RESULTS: At 0 degrees and 15 degrees of knee flexion, 75%, 50%, 25% and 0% of the normal vastus medialis oblique muscle led to a significant difference in lateral patellar shift compared to the normal (P<0.05). CONCLUSIONS: Weakness of the vastus medialis caused the patellar lateral shift at 0 degrees and 15 degrees of knee flexion. RELEVANCE: Weakness of the vastus medialis is thought to be an important factor causing patellar subluxation and dislocation. Understanding the relationship between the vastus medialis weakness and patellar tracking will be useful in diagnosis, treatment and prevention of patellar subluxation and dislocation.

Analysis of Variance↗
PubMedDate not supplied

[Intra-articular dislocation of patella].

The case of a patient aged 73 years who, following an accidental fall on a staircase, suffered an acute intraarticular dislocation in the left knee-cap is presented. This exceptional dislocation presented incarceration of the proximal kneecap pole in the femoral intercondylar groove. A reduction was carried out under general anaesthetic due to pain and muscular contraction in the attempts at reduction without anaesthetic. We made a surgical check that ruled out associated lesions to the extensor apparatus, soft parts, joint structures and osteophytes. The patient presented advanced arthrosis, above all femoral-patellar. Following two weeks of immobilisation, the patient restarted mobility. There has been no relapse or other type of complication.

Aged↗
PubMed2004

Intra-articular dislocation of the patella with incomplete rotation--two case reports and a review of the literature.

Intra-articular dislocation of the patella is a rare clinical condition. Only forty-five cases have been reported. Most of them were encountered in adolescents and required an open reduction. We report two cases in an older age group with an incomplete rotation of the patella, which were successfully treated by closed reduction. We discuss the literature and suggest that the management depends on the degree of patellar rotation.

Acute Disease↗
PubMed2005

Superior dislocation of the patella. Case report and review of literature.

Superior dislocation of the patella is a rare diagnosis, which usually occurs after a trivial trauma. It usually requires manipulation with analgesics or may even need anaesthesia. We report a case of spontaneous reduction of the dislocation, which lead us to believe that this may be more common in the community than has been reported.

Analgesics↗
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↗
PubMed2006

Tibial tubercle transfer on a medial periosteal pedicle--a report of a new technique.

Tibial tubercle transfer is still probably the most widely used procedure of the numerous operative procedures described to realign the patella and extensor mechanism and to prevent a recurrent dislocation. Although this procedure most likely disturbs the blood supply to the tibial tubercle and thus may lead to a delayed union. Tibial tubercle transfer is also considered to play a role in the incidence of a tibial tubercle delayed union. Furthermore, a fracture of the tibial metaphysis has been reported to occur in some cases. We therefore devised a new procedure in which the periosteum of the medial side of the proximal portion of the tibia was left intact when tibial tubercle transfer is performed. The current paper describes the results of new technique in 25 knees with patellar maltracking. Eighty-four percent of the patients had good or excellent results at a mean follow-up time of 49 months. All of the patients achieved complete healing radiographically within 2 months after the operation. Serious complications such as compartment syndrome, infection and skin slough were also completely avoided in all cases. This new procedure that the use of a protective maneuver for the periosteum of the medial side of the tibia may thus reduce the incidence of a delayed union and thereby promote early postoperative rehabilitation after tibial tubercle transfer.

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↗
PubMed2002

Acute traumatic hemarthrosis of the knee. Is routine arthroscopic examination necessary? A study of 320 consecutive patients.

BACKGROUND AND AIMS: Distortions and contusions of the knee are common. Fairly often they will result in hemarthrosis. The purpose of this study was to evaluate the findings in patients with acute traumatic hemarthrosis of the knee and based on these findings estimate the necessity of acute arthroscopic examination. MATERIAL AND METHODS: A total of 320 patients were examined arthroscopically between the years 1994 to 96 in the Turku University Hospital. Patients with other than chondral or osteochondral fractures were excluded. RESULTS: The most common arthroscopic findings were rupture of the ACL (45%), dislocation of the patella (23%) and meniscal tear (21%). In only 113 (35%) cases an immediate therapeutic procedure was performed in addition to the arthroscopic examination. CONCLUSIONS: Based on our findings we believe that routine arthroscopic examination is not necessary in patients with acute traumatic hemarthrosis of the knee. In our opinion the patient should be examined and followed by an orthopedic surgeon and if a lesion requiring operative treatment is diagnosed or suspected, an arthroscopic examination should be scheduled. The timing of the procedure should be such that all possible lesions encountered can be treated in the same operation.

Acute Disease↗
PubMed2004

Lateral patellofemoral ligament reconstruction.

Abstract Medial dislocation of the patella is a disabling condition; there are several reports in the literature describing this condition and its association with failed lateral retinacular release. The diagnosis and treatment of medial subluxation of the patella may be difficult. Direct repair or imbrication of the lateral retinaculum provides initial stability but a noticeable increase in medial excursion usually reappears. In this article, we describe a simple and reproducible technique to reconstruct the lateral patellofemoral ligament with autogenous tissue that is based on the basic principles of all ligament reconstruction. Reconstruction of the lateral patellofemoral ligament is useful in eliminating the symptoms related to medial instability of the patella after failed lateral retinacular release; however, it must be considered a salvage procedure because it does not address the pathomechanics that led to the initial patellofemoral symptoms.

Humans↗
PubMed2006

Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results.

Instability of the patella occurs when it fails to track fully in the femoral groove during knee movement. The groove begins at the metaphysis of the distal femur and extends on its anterior surface inferiorly to the femoral notch. It is normally present at birth and the cartilaginous shape is similar to that of the adult. An abnormal trochlea may be shallow. In extreme cases it may be dome-shaped, where it is associated with recurrent subluxation or dislocation of the patella. In these cases it is logical to consider fashioning a groove as part of a realignment procedure. This study reports the operative technique and early clinical and radiological results of a consecutive case series of the first 15 patients (17 knees) who underwent a deepening trochleoplasty for severe dysplasia developed from that described by Dejour. The follow-up was for a minimum of 1 year (average 3 years, range 1 to 9 years). The boss height was reduced from an average of 7.5 mm (range 6 to 11 mm) to 0.7 mm (range -1 to 3 mm). Tracking became normal in 11 knees and had a slight J-shaped in six. Seven knees had mild residual apprehension. Seven patients were very satisfied, six were satisfied, and two were disappointed. The Kujala score improved from an average of 48 (range 13 to 75) to 75 (range 51 to 98) out of 100 (p<0.05). Three patients returned to full sports. Eight patients required further operations apart from the removal of metallic screws in 10 knees. Five of these were arthroscopic arthrolysis for stiffness at about 6 weeks post-operatively. Trochleoplasty for severe dysplasia of the femoral sulcus is a developing procedure. It requires careful attention to detail. For a rare condition the early results have been satisfactory with an acceptable level of complications.

Adolescent↗