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At least 451 records · Page 25Linked to original sources
PubMed2000

Asymmetric patella resurfacing in total knee arthroplasty.

Three hundred consecutive primary, cemented, condylar total knee arthroplasties (TKAs) were reviewed for the presence of asymmetric patella resurfacing using a postoperative Merchant or sunrise patellar radiograph. Twenty-one knees in 14 patients were found to have the patella asymmetrically resurfaced. Asymmetric resurfacing typically involved the inadvertent preferential resurfacing of the lateral facet with underresection of bone from the medial patellar facet. All patients underwent follow-up for a minimum of 5 years, with a mean follow-up of 7.5 years. Of the 21 knees, 3 revisions were required for patellar complications. One patellar component was loose on radiographs and there was marked patellofemoral pain in 6 knees. Overall, 11 of 21 knees (52%) underwent revision or were recommended for revision for patellar complications or had anterior knee pain that limited activities. Inadvertent asymmetric patella resurfacing using the kinematic condylar implant adversely affects the outcome after TKA.

Aged↗
PubMed2001

Histomorphometric analysis of the normal adult patella.

The patellae of 6 male and 2 female, 40 to 70 year-old individuals, who were healthy at the time of their violent death, were assessed by computer-assisted image analysis. The means of the bone density (percentage of bone in the respective field of interest) ranged from approximately 20% to approximately 30% in the central spongiotic zones, from approximately 40% to approximately 80% in the superior and inferior peripheral zones, and approximately 40% to approximately 60% in the subchondral zone. Bone densities were greatest in the lateral parts of the subchondral and spongiotic territories. The bony trabeculae were haphazardly distributed in the central spongiotic zones. They were commonly oriented vertically or parallel to the surface of the patella in the peripheral and subchondral zones. In conclusion, the histomorphometric data presented validate the rationale of reaming the articular aspect of the patella into a dome-shaped configuration with preservation of a circumferential bony bulwark in the preparation for the implantation of a thick polyethylene-based component with a concave undersurface.

Adult↗
PubMed2001

Orthopaedic measurements with computed radiography. Methodological development, accuracy, and radiation dose with special reference to the weight-bearing lower extremity and the dislocating patella.

The overall aim of this study was to develop and evaluate a measurement system for computed radiography (CR) and Picture Archiving and Communication Systems (PACS), permitting measurements of long distances and angles in and between related images. The developed measurement system, which was based on the QUESTOR Precision Radiography (QPR) system, was applied to the weight-bearing knee with special reference to the dislocating patella. The QPR system modified for CR fulfilled the criteria for measuring the weight-bearing knee. The special measuring assistance tools that were developed were important for the implementation of CR and PACS, particularly in workstations programmed for musculoskeletal radiology. The energy imparted to the patient was reduced by 98% at the lowest exposure of the CR-system, compared with our conventional analogue method, without loss of diagnostic accuracy. The CR technique creates a possibility, to an extent not previously feasible, to differentiate the exposure parametres (and thus minimise the radiation dose to the patient) by carefully considering the purpose of the examination. A radiographic method for measuring the rotation of the femur and the tibia, the Q-angle, and the patellar translation was developed and applied to healthy volunteers. The introduced patellar variables have yielded new insights into the complex sequence of motions between the femur, tibia, and patella. The patients with a dislocating patella were subdivided into one "clean" group of spontaneous dislocations and one group with various traumas in the history, which thus resulted in two groups with distinct radiographic differences. The Q-angle was decreased in knees that had suffered dislocations, and the traditional surgical treatment with a further reduction of the Q-angle must be challenged. The use of clinical measurements of the Q-angle was not an optimal way to evaluate the mechanical alignment in the patellofemoral joint under physiological conditions. In this study, we have proved that the developed method for CR and PACS is a useful technique for measurements in and between related images, and is superior to the conventional analogue technique.

Adolescent↗
PubMed2002

The course of pregnancy in a patient with nail-patella syndrome.

INTRODUCTION: The nail-patella syndrome is a rare autosomal dominant condition with high penetrance. Pregnancy in such a patient is rare and we believe this to be the first report of a live birth occurring in a patient with nail-patella syndrome. CLINICAL PICTURE: A 25-year-old patient presented in her first pregnancy with nephrotic syndrome associated with characteristic bone abnormalities and nail dysplasia and was later diagnosed to have nail-patella syndrome. In her second pregnancy, the course of her pregnancy was complicated by further deterioration of renal function with superimposed pre-eclampsia resulting in early delivery at 28 weeks. CONCLUSION: Such pregnancies should be regarded as high risk and managed jointly with the renal physician in a tertiary care centre to ensure an optimal outcome to the mother and baby.

Adult↗
PubMed2002

[Retro-trochlear wedge reduction trochleoplasty for the treatment of painful patella syndrome with protruding trochleae. Technical note and early results].

PURPOSE OF THE STUDY: Patients with painful patella syndrome without objective instability are often treated by section of the lateral retinacular of the patella or advancement osteotomy of the tibial tuberosity with less than satisfactory mid-term results. One explanation of the persistent pain could be hyperpression within the femoro-patellar joint due to excessive protrusion of the trochleae (>=7 mm). We propose retro-trochlear wedge resection to achieve reduction trochleoplasty. The wedge is cut with a superior base so the trochlear angle remains unchanged. We describe here the operative technique and report early results at more than two years follow-up. MATERIAL AND METHOD: We reviewed retrospectively 12 knees treated with trochleoplasty for painful patella syndrome. Eleven of these knees had had previous operations for objective (n=9) or potential (n=2) patellar instability. Mean follow-up was 4 years (range 2-6). A complete pre- and postoperative radiological work-up was obtained for all knees including 30 degrees flexion femoropatellar views and computed tomography measurements of TA-GT value at 30 degrees flexion. Functional outcome was studied with the Arpege scale. Trochleoplasty was performed via an anterolateral approach and was associated with frontal translation of the tibial tuberosity if the preoperative TA-GT was not in accord with the trochlear angle. RESULTS: Functional outcome improved during the first two postoperative years then stabilized. Improvement in pain and instability was statistically significant. Functional outcome was scored good or very good for nine knees. The two failures occurred in the oldest patients whose knees had had several operations. Mean trochlear protrusion was 8 mm preoperatively and 3 mm postoperatively. All trochleoplasties healed; there was no trochlear necrosis. DISCUSSION: The described trochleoplasty has an advantage over classical reduction trochleoplasty because it does not modify the trochlear angle. In addition, it is quantifiable. It is biomechanically more logical than advancement of the tibial tuberosity. In our patients, the trochlear protuberance was reduced to 3 mm. Associated with correction of mechanical femoro-patellar anomalies in the frontal plane, this trochleoplasty can provide good relief even in patients with persistent pain in previously operated knees treated for objective or potential patellar instability or for simple patellar pain.

Adult↗
PubMed1976

Chondromalacia Patellae. A prospective study.

In a prospective study of 105 arthrotomies for chondromalacia patellae, patella alta or an increased Q angle was found in most of the knees and was considered to be the usual cause of chondromalacia. The chondromalacia on the patella was usually centrally located with extension equally onto the medial and lateral facets. Femoral changes were uncommon. Patellar realignment together with excision of chondromalacic cartilage gave a satisfactory result in 79 per cent of the eighty-seven knees that could be followed.

Adolescent↗
PubMed1998

[A human knee articulate mathematical model on femur-tibia-patella 3-segmetents].

In this paper, based on the previous work of S. Turgut Tumer et al, a human knee articulate mathematical model on femur-tibia-patella 3-segments is established by introducing patella-femur joint. This model includes both rolling and slipping motions of femur-tibia joint and femur-patella joint. It can be employed in simulating the biodynamic response of human lower extremity.

Biomechanical Phenomena↗
PubMed2003

Dynamics of muscle strength improvement during isokinetic rehabilitation of athletes with ACL rupture and chondromalacia patellae.

AIM: To assess quantitatively dynamics and extent of the increase in muscle strength during isokinetic rehabilitation. METHODS EXPERIMENTAL DESIGN: daily measurements of muscle strength; detailed testing at the beginning and at the end of rehabilitation. SETTING: Cybex Rehabilitation Center, Zagreb. SUBJECTS: 44 athletes (31 m, 13 F, age 16-35), 3 injury-defined groups: athletes with ACL rupture (non-reconstructed and reconstructed) and chondromalacia patellae. INTERVENTIONS: all subjects underwent isokinetic rehabilitation on Cybex Orthotron KT2 device, using individually designed protocols (extension and flexion exercises, concentric muscle contractions, 15 treatments). MEASUREMENTS: monitoring of daily progress on rehabilitation device and detailed testing on diagnostic device. RESULTS: All patients showed considerable improvement. Muscle strength improved on average 141% (SD=110) in ACL-reconstructed group, 144% (SD=130) for chondromalacia patellae group and 150% (SD=74) for ACL-non-reconstructed group, comparing to initial strength. Dynamic status tested on Cybex Otrhotron diagnostic device prior and after rehabilitation strongly correlated with final progress monitored on the rehabilitation device. CONCLUSION: Isokinetic rehabilitation is a quick and effective method in treating knee injuries in athletes. Both types of objective criteria have shown significant increase in muscle strength. The improvement of muscle strength was on the average 149% (SD=101), which is about 10% daily for 15 treatments. The greatest progress, 19% per day, occurred during first five days. The athletes were able to resume their sport activities as follows: patients from chondromalacia patellae group, and most of them from the non-reconstructed ACL group were back in competition within a month, while 75% from the ACL reconstructed group came back within 3 months, and the rest of them within 5 months.

Adolescent↗
PubMed2003

Secondary resurfacing of the patella for persistent anterior knee pain after primary knee arthroplasty.

Out of a total of 623 patients who, over a ten-year period, underwent primary total knee replacement (TKR) without patellar resurfacing, 20 underwent secondary resurfacing for chronic anterior knee pain. They were evaluated pre- and postoperatively using the clinical and radiological American Knee Society score. The mean follow-up was 36.1 months (12 to 104). The mean knee score improved from 46.7 to 62.2 points and the mean functional score from 44.7 to 52.2 points. Only 44.4% of the patients, however, reported some improvement; the remainder reported no change or deterioration. The radiographic alignment of the TKR did not influence the outcome of secondary resurfacing of the patella. Complications were noted in six of the 20 patients including fracture and instability of the patella and loss of movement. Anterior knee pain after TKR remains difficult to manage. Secondary resurfacing of the patella is not advocated in all patients since it may increase patient dissatisfaction and hasten revision.

Aged↗
PubMed2003

Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children.

We investigated the clinical outcome of a reconstructive procedure of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in four children (6 knees), with a minimum follow-up of four years. The technique involves transfer of the tendon of semitendinosus to the patella using the posterior one-third of the femoral insertion of the medial collateral ligament as a pulley. There was no recurrence of dislocation after surgery. The mean Kujala score at follow-up was 96.3 points. Radiological assessment showed that the congruence angle, the tilt angle and the lateral shift radio were restored to normal. The lateral and medial stress shift ratios and the Insall-Salvati ratio remained abnormal. We conclude that this technique can be recommended for the treatment of habitual or recurrent patellar dislocation in children, although hypermobility and patella alta are not fully corrected.

Child↗
PubMedDate not supplied

[The nail-patella syndrome].

The nail-patella syndrome (synonym of onychoosteodysplasia) is considered to be an autosomal dominant hereditary disease affecting numerous tissues of ectodermal and mesodermal origin. The changes are mostly found on nails, patellae, eyes and joints. The symptoms of nephropathy are present in 30% to 40% of patients, and renal insufficiency with typical signs of the syndrome in 25% of patients. This report describes a female patient with renal insufficiency on chronic hemodialysis treatment, in whom diagnosis of the nail-patella syndrome has been made at 36 years of age. The incidence of the syndrome has been noted in 11 members of the patient's family, but without clinical signs of nephropathy.

Female↗
PubMed1990

[Results of treating recurrent dislocation of the patella by the Garlick-Salamon method].

The Garlicki-Salamon method consists in isolation of the patella ligaments, loosening of the lateral pulleys, medial and downward transposition of the patella ligament insertion, wrapping of the medial joint capsule, and transfer of the m. vastus medialis insertion to the medial-upper quadrant of the patella. The late follow-up (at least 5 years of observation) was carried on in 26 knees. 4 results were excellent, 10 -- good, 8 -- fair, 4 -- poor. In nine cases (35 per cent) development osteoarthritis of the patello-femoral joint was found. Recurrence of dislocation was found in 4 cases.

Adolescent↗
PubMed2003

Painful bilateral bipartite patellae--case report.

Bipartite patella is usually asymptomatic. Painful bipartite patella is either non-surgically managed by immobilization, anti-inflammatory drugs and physical therapy or treated by excision. We report a case in whom locally injected bupivacaine and steroid (methylprednisolone acetate) injection relieved the symptoms completely in a case of bilateral painful bipartite patellae.

Adult↗
PubMedDate not supplied

Nail-patella glomerulopathy without associated constitutional abnormalities.

A 17-year-old boy presented with a history of longstanding hematuria and non-nephrotic proteinuria without renal insufficiency, for which renal biopsy was performed. The findings by routine light microscopy and direct immunofluorescence study were mild and nonspecific. Electron microscopy, however, demonstrated the unexpected finding of distinct collagen fibrils within capillary wall basement membranes, typical of the nail-patella syndrome. Repeat physical examination following the biopsy confirmed the presence of normal nails and patellae, and radiographs of the knees were also normal. The boy's renal disease was stable at last follow-up. The authors briefly discuss the differential diagnosis, and suggest that this case represents an unusual manifestation of the nail-patella syndrome, in which the glomerular changes are present in the absence of the usual associated constitutional abnormalities.

Adolescent↗
PubMed2005

"Created" patella in total knee arthroplasty (TKA) after prior patellectomy.

Currently, total knee arthroplasty (TKA) is one of the most successful orthopaedic surgeries. However, the results are inferior in patients with previous patellectomy because of anteroposterior instability, residual pain, and loss of the mechanical advantage of the patella. The moment arm of the quadriceps can be restored by bone grafting the patellar tendon, and thus regaining the benefits of an intact patella that results in a better outcome after TKA. Usually it requires an additional procedure with its associated co-morbidities to harvest the bone graft. As the bone graft has to articulate with the femoral prosthesis, it has to be smooth at least on one side. The authors have described a new technique in this Chapter by which bone grafting of the patellar tendon can be achieved with use of the tibial plateau obtained from the routine tibial cut during TKA. Tibial eminence can be used as the interfacetal ridge of the "created" patella.

Arthroplasty, Replacement, Knee↗
PubMed2006

Cementless LCS rotating-platform knee arthroplasty in patients over 60 years without patella replacement: a mid-term clinical-outcome study.

BACKGROUND: The aim of this prospective paper is to present the results of a cementless LCS rotating-platform artificial knee design without resurfacing of the patella in patients over 60 years of age. MATERIAL/METHODS: In this prospective series, 234 patients were included with 251 knees. The LCS rotating-platform uncemented design was used in all cases, without replacement of the patella. Thirty-four patients were men and 200 were women. Two hundred three patients were suffering from osteoarthrosis (10 bilateral) and 31 patients (7 bilateral) from rheumatoid arthritis. Seventeen patients had a bilateral procedure. Prophylactic antibiotics and anticoagulants were also instituted to all patients. RESULTS: Forty-nine patients developed deep vein thrombosis and responded well to the applied conservative treatment. Overall results in the first 251 cementless cases at 2 to 9.8 years' follow-up (average: 5.7 years) were good to excellent in 94.4%, fair in 4.7%, and poor in 0.7%. Radiographs of the knees showed good bonding and no signs of radiolucency. The average clinical and functional Knee Society Ratings were 21.07 points and 30.95 points, respectively, preoperatively and 87.95 points and 78.56 points, respectively, at the final follow-up evaluation. CONCLUSIONS: With an average follow-up of 5.7 years, uncemented LCS rotating-platform knee joint arthroplasty without replacing the patella in patients over 60 years old was found to perform well, with encouraging clinical and radiological results and a survival rate of 98.1%.

Aged↗
PubMed1991

[Distribution of transverse dimensions of the patella in the adult population. Relation to the development of the patellar component in knee joint prosthesis].

The development and manufacture of the patellar component was associated with a more detailed osteometric investigation of the patella and evaluation of its range of sizes in our population. Evaluation of data 1042 probands (477 women, 565 men) proved: a) there are no significant lateral differences of transversal dimensions of the patella and femoral condyles; b) The mutual relationship of the above mentioned dimensions does not correlate, and thus no conclusions can be drawn from the transversal breadth of the condyles on the dimensions of the patella; c) The range of patellar diameters in the population is very wide, and to meet demands, it will be necessary to manufacture patellar components in cca five sizes.

Adolescent↗
PubMed1991

[An experimental study on early changes of articular cartilages in subluxated patella of rabbits].

The pathogenesis and clinical progress of chondromalacia patellae have not been well studied in experimental models. We, therefore, studied the patellar subluxation produced experimentally in rabbit knees. In this model, sequential changes of the patellar cartilage were followed by simple X-rays, CT, macroscopic, histologic and scanning electron microscopic examinations up to 32 weeks. Pathological changes extending from horizontal fissures in the middle to the deep layers of the patellar cartilage and thinning of the subchondral bone were found at about six weeks after operation. The early changes of chondromalacia patellae were mostly what is called the basal degeneration, which was presumably attributed to the shearing stress on the articular cartilage. The sequential changes were not very remarkable; none of the rabbits developed OA changes by thirty-two weeks after operation. From these findings, we have that the cartilaginous changes in chondromalacia patellae progress very slowly which probably result from the vigorous repair by the cartilage and also from the acquisition of adaptability on the patellofemoral joint.

Animals↗