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At least 433 records · Page 24Linked to original sources
PubMed1983

Why not resurface the patella?

The results of resurfacing or not resurfacing the articular cartilage of the patella were reviewed in 71 knees--47 with rheumatoid arthritis and 24 with osteoarthritis--which had been replaced with the ICLH prosthesis. Two rheumatoid and osteoporotic patellae developed transverse fractures with separation and were excluded from the review. The results showed that resurfacing the patella greatly reduced peripatellar pain with no counter-balancing disadvantage.

Aged↗
PubMed1985

Fragmentation of the proximal pole of the patella. Another manifestation of juvenile traction osteochondritis?

Six boys with fragmentation of the proximal pole of the patella are reported; the condition was bilateral in one. Four of the six presented with symptoms of Osgood-Schlatter's disease or Larsen-Johansson disease of the same or of the contralateral knee, but they had no symptoms or signs relating to the proximal pole of the patella; one also had features suggesting minimal chondromalacia patellae. Two boys had no objective abnormality in either knee. It is suggested that the fragmentation may be a further form of traction osteochondritis of the attachments of the quadriceps mechanism. Attention is drawn to its characteristic radiographic appearance, its association with other forms of juvenile traction osteochondritis (which are commonly symptomatic), and to its occurrence in boys aged 10 or 11 years.

Child↗
PubMed1986

Radiographic assessment in patellar instability and chondromalacia patellae.

Minor degrees of malalignment of the patella and anatomical abnormalities including a flattened sulcus angle and an increased ratio between patellar tendon length and patellar length (PT:P) have been suggested as predisposing factors in the causation of chondromalacia patellae, as well as patellar instability. In order to confirm or refute this hypothesis a prospective study has been performed comparing the congruence and sulcus angles and the PT:P ratio in a group of 35 patients with chondromalacia confirmed by arthroscopy and a group of 33 patients with instability, with those of a group of 50 knees in normal volunteers. While there was a statistically significant correlation between an increased sulcus and congruence angle and a high-riding patella in patients with instability, no correlation could be identified in patients with idiopathic chondromalacia.

Adolescent↗
PubMed1987

Double patella. A case of duplication in the coronal plane.

A case of duplication of the patella in the coronal plane is reported. Previously reported cases of double patella have shown sagittal or vertical duplication, and some have been associated with multiple epiphyseal dysplasia. In our case, excision of one patella and realignment of the extensor mechanism relieved symptoms of giving-way.

Child↗
PubMed1990

Acute dislocation of the patella. A prospective review of operative treatment.

We report a prospective study of 55 patients with acute primary patellar dislocation, all treated by operation and followed up for at least two years. Diagnosis was based on the history of a lateral displacement, with medial tenderness and a positive apprehension test; redislocations were excluded. Before operation, the difference in lateral shift on skyline views of the injured and control patellae was highly significant. At operation, rupture of the medial retinaculum of the patella was seen in all but one case. There were medial marginal fractures of the patella in 23 cases. Subjective results of the operation were excellent or good in 44 of the 55 at two years with a redislocation rate of only 9%. Most patients were able to return to the same level of sporting activity as before the injury.

Adolescent↗
PubMed1998

Treatment of painful articular cartilage defects of the patella by carbon-fibre implants.

Between 1989 and 1993 we implanted a matrix support prosthesis made of carbon fibre for the treatment of chronic painful articular defects of the patella in 27 patients. The mean period of follow-up was 33 months (11 to 54) with clinical and arthroscopic evaluation of the implant. Overall, there were four excellent, three good, seven fair and 13 poor results. Nine patients subsequently had a patellectomy for persistent pain at a mean of 27 months after surgery (14 to 47). The mean visual analogue pain scores in those who retained their patella were 7.6 before operation and 5.5 at the time of the latest follow-up. Patient satisfaction for the entire group was 41%. There appeared to be good incorporation of the prosthesis and a satisfactory ingrowth of fibrocartilage, but the poor results in 48% and low patient satisfaction discourage us from recommending the procedure for lesions of the articular cartilage of the patella. The consistent seeding of the joint with carbon-fibre debris and a histiocytic giant-cell reaction in the synovium are also a cause for concern.

Adolescent↗
PubMed2003

Soft-tissue anatomy anterior to the human patella.

BACKGROUND: The purpose of this anatomic study is to report the results of dissections of the soft-tissue structures anterior to the human patella. METHODS: Sixty-one fresh or fresh-frozen and thawed human cadaver knees were dissected for this study. Thirty-five of the knees were from men, and twenty-six were from women. The soft-tissue structures anterior to the patella were dissected layer by layer and documented photographically. RESULTS: Fifty-seven (93%) of the sixty-one knees were found to have a trilaminar arrangement of fibrous soft-tissue structures anterior to the patella from superficial to deep. Those structures included a transversely oriented fascia, an obliquely oriented aponeurosis, and the longitudinally oriented fibers of the rectus femoris tendon. Between the soft-tissue fibrous layers, there were three prepatellar spaces that can be termed bursae: a prepatellar subcutaneous bursa, a prepatellar subfascial bursa, and a prepatellar subaponeurotic bursa. Four of the sixty-one knees lacked an intermediate oblique aponeurotic layer. In none of the sixty-one knees was there a potential bursal space between the rectus femoris tendon and the anterior patellar bone. CONCLUSIONS: These anatomic findings are at variance with descriptions in standard anatomic orthopaedic texts and periodical literature, including the Nomina Anatomica. None of those texts accurately describe the presence of a prepatellar aponeurotic layer or a prepatellar subaponeurotic bursa. Also, in contradistinction to descriptions in the anatomic literature, including the Nomina Anatomica, no prepatellar subtendinous bursa was found in any of the sixty-one knees.

Adult↗
PubMed1992

Chondromalacia patellae: diagnosis with MR imaging.

Most previous studies of MR imaging for detection of chondromalacia have used T1-weighted images. We correlated findings on axial MR images of the knee with arthroscopic findings to determine MR findings of chondromalacia patellae on T2-weighted and proton density-weighted images. The study population included 52 patients who had MR examination of the knee with a 1.5-T unit and subsequent arthroscopy, which documented chondromalacia patellae in 29 patients and normal cartilage in 23. The patellar cartilage was assessed retrospectively for MR signal and contour characteristics. MR diagnosis based on the criteria of focal signal or focal contour abnormality on either the T2-weighted or proton density-weighted images yielded the highest correlation with the arthroscopic diagnosis of chondromalacia. When these criteria were used, patients with chondromalacia were detected with 86% sensitivity, 74% specificity, and 81% accuracy. MR diagnosis based on T2-weighted images alone was more sensitive and accurate than was diagnosis based on proton density-weighted images alone. In conclusion, most patients with chondromalacia patellae have focal signal or focal contour defects in the patellar cartilage on T2-weighted MR images. These findings are absent in most patients with arthroscopically normal cartilage.

Adolescent↗
PubMed2000

Deferoxamine-induced bone dysplasia in the distal femur and patella of pediatric patients and young adults: MR imaging appearance.

OBJECTIVE: We investigated the MR imaging appearance of deferoxamine-induced bone dysplasia in the distal femur and patella in patients with thalassemia major. MATERIALS AND METHODS: Thirty-five patients with homozygous ss-thalassemia major who were undergoing regular transfusions and chelation therapy underwent coronal T1-weighted MR imaging of the femur, including the femoral head and the distal femoral epiphysis. Additional coronal fat-saturated dual-echo and sagittal T1-weighted images of the distal femur and patella were obtained in 11 patients who were suspected of having distal femoral lesions on the basis of the coronal T1-weighted images of the entire femur. RESULTS: No dysplastic change was detected in the proximal femur on coronal T1-weighted images. In 22 distal femurs of 11 patients, the following abnormalities were detected on MR imaging: blurred physeal-metaphyseal junction (n = 22), distal metaphyseal areas of hyperintensity (n = 21), physeal widening (n = 18), metadiaphyseal lesions (n = 11), epiphyseal lesions (n = 10), and patellar lesions (n = 2). Physeal widening and distal metaphyseal hyperintense areas were all more pronounced peripherally. Of the 21 distal metaphyseal hyperintensities, lateral abnormalities were larger than medial abnormalities in 16. Of the 18 distal femurs in which physeal widening was detected, the lateral widening was more marked than the medial widening in 12. Patients with MR imaging evidence of bone dysplasia have a significantly (p = 0.003) greater height reduction than patients without such evidence of bone dysplasia. CONCLUSION: Deferoxamine-induced bone dysplasia in the distal femur and patella is represented by a spectrum of morphologic changes in the epiphysis, physis, metaphysis, and metadiaphysis on MR imaging.

Adolescent↗
PubMed1976

Distal disinsertion of the patellar ligament combined with avulsion fractures at the medial and lateral margins of the patella. A case report and an experimental study.

A 12-year-old boy presented with a proximally retracted patella 5 months after an injury to the left knee. The clinical and radiographic features and the findings at operation led to the conclusion that the original lesion had been a distal disinsertion of the patellar ligament combined with avulsion fractures at the medial and lateral margins of the patella, produced by the medial and lateral longitudinal patellar retinacula. Loading experiments on amputation and cadaver specimens showed that these retinacula, apart from being tendons for the vastus medialis and the vastus lateralis, respectively, constitute a direct fibrous connection of considerable strength between the patella and the tibia and thus are capable of producing avulsion fractures.

Adult↗
PubMed1981

Perichondrial autograft in traumatic chondromalacia patellae. Report of a case.

A case of clinically successful autografting of rib perichondrium to the patella in a 55-year-old woman suffering from painful traumatic chondromalacia patellae is reported. A postoperative arthrogram however did not show any significant regeneration of cartilage but arthroscopy revealed a smooth surface of cartilage on the patella. Biopsies were not performed.

Cartilage↗
PubMed1982

Chondromalacia patellae: a radiographic study of the femoropatellar joint.

X-rays of 71 patients operated on for chondromalacia patellae were examined in order to obtain a comprehensive picture of the radiographic changes in this disease. Ninety-seven patients with a normal patellofemoral joint - found at operation - were used as a control group. We found a significantly higher frequency of patella alta and the presence of Haglund's excavation in patients with chondromalacia but had to conclude that ordinary X-rays cannot be used to confirm the diagnosis chondromalacia patellae.

Adolescent↗
PubMed1988

A chronically dislocating prosthetic patella. A case report.

A 63-year-old white woman was evaluated for a chronically dislocating right patella 6 months following total knee arthroplasty. At the time of our initial evaluation, her knee would not extend beyond 35 degrees and her patella was dislocated and irreducible. At arthrotomy, when the patella was everted, the patellar component was oriented with the facet ridge rotated 90 degrees to the trochlear groove of the femoral component. The patellar template guide indicated that the fixation pegs had been drilled properly, and thus, the patellar component had been assembled improperly during manufacturing. After dome-type patellar prosthesis replacement and proximal and distal extensor realignments were performed, 2 months post-revision the patient had a range of motion from 5 degrees to 95 degrees and ambulated with no patellar instability or pain.

Equipment Failure↗
PubMed1998

Medial subluxation of the patella without previous lateral retinacular release.

This case presented a 17-year-old patient with persistent complaints localized to the right patellofemoral joint. Clinical examination demonstrated increased medial translation of the patella on manual stress. In contrast to previous published reports on medial patellar subluxation, this patient had not undergone prior lateral retinacular release. Arthroscopic examination documented medial tracking of the patella as well as excess medial translation. Imbrication of the patient's lateral patellar retinaculum centralized patella tracking and diminished medial translation on stress testing as observed arthroscopically and clinically. This case illustrates that medial patellar subluxation is a subtle problem that may be overlooked in the patient presenting with patellofemoral complaints and should be included in the differential diagnosis.

Adolescent↗
PubMed1999

Fracture of the patella following total knee arthroplasty.

The charts of 21 patients (22 knees) with significant radiographic changes of the patella after total knee arthroplasty were reviewed. The average patient age was 73 years, and average follow-up after arthroplasty was 7.3 years. Lateral release, fat pad excision, quadriceps tendon release, and previous surgery were implicated in the etiology of fracture of the patella. Five cases had type 1 pattern (sclerosis, fragmentation, and no fracture), 5 cases had type 2 pattern (undisplaced fracture and fragmentation), and 12 cases had type 3 pattern (displaced fracture and fragmentation). Type 1 and 2 patterns required no surgical treatment and were rated good to excellent according to the Hospital for Special Surgery Disability Score Sheet. Patients with a type 3 pattern who did not undergo surgery were rated poor to fair, while patients with a type 3 pattern who underwent surgical treatment (patellectomy, removal of the patellar component, or excision arthroplasty for infection) were rated good. Patellectomy is the treatment of choice for patients with displaced fractures of the patella. A classification system for the pattern of patellar changes is proposed.

Aged↗
PubMed2005

Surgical treatment options for patella tendon rupture, Part I: Acute.

Patella tendon rupture is a debilitating injury. Prompt diagnosis and treatment is essential to prevent retraction of the patella with subsequent adhesions and quadriceps contractures. In a young patient with an acute rupture, primary repair usually is possible with various methods described to protect the repair. In acute injuries with inadequate tissue, augmentation with hamstring tendons or allograft generally is necessary. Because of the different types of rupture and the possibility for poor quality tissue, the surgeon should always be prepared to combine different techniques to obtain tthe best repair. Continuous passive motion generally can be initiated early with a secure repair. In patients with a patella tendon ruptured that is promptly diagnosed, securely repaired, and followed closely through their rehabilitation, good results can be expected.

Contraindications↗
PubMed1999

Nail-patella syndrome: an incidental finding from abdominal discomfort.

An otherwise healthy 18-year-old woman had abdominal discomfort. Physical examination and laboratory studies were unremarkable, with the exception of nail dystrophy of the ulnar digits. An abdominal plain film revealed bilateral posterior iliac horns, pathognomonic of nail-patella syndrome. Additional radiographs showed hypoplastic patellas bilaterally. While glomerulonephritis occurs in 30% of patients with nail-patella syndrome, there was no evidence of renal involvement.

Abdominal Pain↗
PubMed2000

Isolated skeletal metastasis to the patella.

Metastases to the patella are rarely described in the literature. A 51-year-old man with stage IIIB adenocarcinoma presented to our clinic. One year after radiation and chemotherapy treatment, it was found that he had a metastasis in the right patella. Six months after incisional biopsy with curettage of the patellar lesion and placement of methylmethacrylate bone cement into the remaining patellar defect, he has no pain and is ambulatory. This case has been presented as a basis for palliative surgery in a patient with a rare metastatic tumor of the patella.

Adenocarcinoma↗