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At least 487 records · Page 27Linked to original sources
PubMed1981

Fractures of the patella. One hundred consecutive cases.

The series comprises 100 patella fractures treated during the period 1974-1977. Seventy-eight patients were treated operatively. The most common operative method was partial excision, which was performed in 36 patients. Twenty-four patients were treated with equatorially placed cerclage wires, while 10 patients were treated with tension band fixation only (AO). All the operated patellas were immobilized postoperatively in a plaster cast cylinder for a mean duration of 5.2 weeks. The average observation time was 18 weeks. At follow-up attention was paid to subjective symptoms and radiological findings, clinical status and duration of incapacity for work. The clinical results were considered excellent or good in 71 patients and the subjective assessments were excellent or good in 63. Superficial infections were recorded in three cases and in seven patients the osteosynthesis had deteriorated. The results suggest that tension band fixation and partial excision of the patella are methods of choice for patellar fractures requiring operative management.

Adolescent↗
PubMed1981

[Experimental study of chondromalacia patellae (author's transl)].

There are many theories concerning the etiology of chondromalacia patellae, as well as many points which have not been fully investigated yet. Using rabbits experimentally, shortening and elongation of the 3 mm patellar ligament were performed, producing the changes of contact surface and pressure on the patellar cartilage, and the patellar cartilage and the subchondral bone were studied sequentially. In the group of shortening, after the course of 16 weeks, no particular changes were recognized in the cartilage and the subchondral bone, compared with the control. In the group with elongation, 2-4 weeks after the operation, thinning of the trabecular and the subchondral bone, proliferation of blood vessels in the subchondral bone and their invasion into the calcified cartilage, were seen, without abnormality in the articular cartilage. After 4 weeks, irregularity or disappearance of the tide mark and degeneration of the ground substance toward the deep layer of the cartilage began to be recognized. After 8 weeks fasciculation was produced in the ground substance from the deep to the middle layers of the cartilage. After 12 weeks, degeneration extended to the superficial layer of the cartilage, producing blister formation, fibrillation and fissura, and finally proceeding to the desquamation of the superficial layer, degeneration and decrease in the thickness of the cartilage. These findings are similar to the histological findings of chondromalacia patellae, and seem to be different from those of arthrosis deformans in the bony changes. It is further suggested that decrease of contact surface and pressure on the cartilage can be considered to be one of the causes for chondromalacia patellae.

Animals↗
PubMed1981

Biochemical changes in the articular cartilage of the patella and femoral condyles in the lateral hyperpatellar syndrome.

The biochemical changes in the articular cartilage of the femoral condyles and the patella were studied during the earliest stage of patello-femoral arthrosis, with particular reference to chondromalacia of the patella in the "lateral hypertension syndrome", with the object of comparing them with the results obtained by Boni et al. (1977) in the initial phases of experimental arthrosis induced in rabbits by means of vitamin A. The biochemical determinations were done on samples of cartilage removed at operation from the medial and lateral femoral condyles and the medial and lateral patellar articular facets in ten patients. The biopsy samples were fixed in 80% alcohol and dried in the oven at 50 degrees C for twenty-four hours. The hexosamine and hydroxyproline content was then determined. This investigation demonstrated significant biochemical changes in this syndrome in the four areas examined. The data obtained indicate that only the mucopolysaccharide component of the joint cartilage is involved at this stage. The most interesting finding was marked diminution in the galactosamine/glucosamine ratio, which was markedly diminished - the opposite of what occurs in established arthrosis. These data appear to be identical with those found in the early phases of vitamin A induced arthrosis in experimental rabbits. The diminution of hexosamine content and the diminished galactosamine/glucosamine ratio were more marked in the femoral condyles, which appeared to have few lesions macroscopically. These changes were also present in both articular facets of patella, but were less marked, probably because the degeneration was more advanced in those areas, thus more closely resembling frank arthrosis.

Adolescent↗
PubMed1980

Efficacy of various forms of fixation of transverse fractures of the patella.

To determine whether any of the commonly used wiring techniques are rigid enough to allow early motion in the treatment of transverse fracture of the patella, the patellae of twenty-five fresh cadaver knees were fractured transversely and fixed using the following techniques: circumferential wiring, tension-band wiring, Magnusson wiring, and a modification of tension-band wiring. The knees were mounted in a machine capable of measuring quadriceps force, flexion angle, and fracture separation simultaneously. The knees were extended from 90 to zero degrees by applying tension to the quadriceps tendon with the force of gravity as the only resistance, and separation of the fracture fragments was measured first with the retinaculum unrepaired and then again with the retinaculum repaired. Separation of the fracture fragments was much less with the Magnusson wiring and modified tension-band wiring than with circumferential wiring or standard tension-band wiring. The retinacular repair was found to contribute to stability; however, this seemed most important in the less rigid repairs. We concluded that if early motion is to be used in treating transverse fractures of the patella, techniques in which the wire is anchored directly in bone should be used and the retinaculum should be repaired.

Cadaver↗
PubMed1980

Fracture of the resurfaced patella in total knee replacement.

Nontraumatic transverse stress fractures of the resurfaced patella occurred in 2 patients, one with a total condylar and the other with a GUEPAR arthroplasty. The blood supply of the patella is a critical factor in both pathogenesis and healing of stress fracture of the patella.

Aged↗
PubMed1980

Congenital dislocation of the patella.

This is a report of 2 rare, neglected congenital irreducible complete lateral dislocations of the patella. The patients were boys, 10 and 13 years old. The dislocations were designated irreducible because closed manipulative effects were invariably failures and the dislocations are permanent because they persist from birth until openly reduced. The deformity was neglected for years (one patient through childhood, the other into adolescence) during which time the anomalous defects were exacerbated by adverse growth changes. The propitious time (late infancy or early childhood) for open reduction and patellar stabilization with an excellent prognosis had long since passed by the time the patients were first seen by an orthopedic surgeon. Neglect had not only caused them to grow up as cripples, but had also rendered their patellae more difficult to reduce surgically. Neglect also increased the challenge to their surgeon to stabilize their patellae and to cope with their needless and preventable secondary deformities by multiple surgical interventions with decreased prospects of emerging free of residual problems and disabilities. In the growing child with active proximal tibial epiphyseal cartilage, interference with growth was avoided by patellar stabilization using the W. T. Green technique for quadricepsplasty. In the adolescent boy, who was closer to skeletal maturity, patellar stabilization was effectually accomplished by transplanting the tibial tuberosity medially and distally with relative impunity and reinforcing it with a Campbell sling. Angular and linear limb deformities were treated by epiphysiodeses. Prolonged dislocations result in loss of normal articular contours, and nonuse of articular cartilages has a morbid effect; both predispose the joint to early degenerative arthritis. Early diagnosis and early referral for orthopedic care are imperative because delay vitiates the ultimate result.

Adolescent↗
PubMed1980

[Experiences and results of 1300 indentation operations for proximal medialization of the patella].

Of 1039 patients, 1300 knee joints were operated on for chondropathia patellae or patellofemoral osteoarthrosis; the results are arranged in tabular form. The basic operation was proximal medialization of the patella by indent operation. Additional interventions like retropatellar should be indicated by an experienced surgeon. The excellent results found 6, 12, 40, and 60 months after the operation recommmend this procedure for the treatment of chondropathia patellae or osteoarthrosis.

Adolescent↗
PubMed1980

[3-dimensional photo-elastometric study of the patella (knee cap). Methodology and initial results].

Thanks to the photo-elastic method, the authors have described the disposition of the quadricipital tensile stresses in the human patella. Photo-elasticity allows the study of the relations between birefraction and stresses which exist in a transparent medium. Up to now, all the studies have been made on a plane model. The original feature of this study lies in the use of a three-dimensional model which, better than any plane photo-elasticimetry, makes it possible to display bone stresses in the three-dimensional space. After reminding some fundamental data, the authors describe the methodology and give the first qualitative results: in a frontal plane, tensile stresses are localised in the anterior two-thirds of the patella; on the contrary, pressure stresses can be observed in the posterior third. So the patella moves forward the tensile stresses of the knee.

Biomechanical Phenomena↗
PubMed1994

Comparison of axial T1 spin-echo and T1 fat-saturation magnetic resonance imaging techniques in the diagnosis of chondromalacia patellae.

To test the diagnostic value of T1 spin-echo and T1 fat-saturated magnetic resonance images (MRIs), we reviewed axial T1-weighted images with and without fat saturation in 20 patients with clinically suspected chondromalacia of the patella. All scans were obtained on 1.5-MR units. The scans were randomly ordered and reviewed independently at different times by two radiologists without knowledge of the arthroscopy results. The sensitivity of the individual techniques for detecting grade 3 or 4 chondromalacia patellae was 92% for fat-saturated axial T1-weighted images alone, and 67% for axial T1-weighted images without fat saturation. The sensitivity of the combined techniques was 100% for grades 3 and 4 and 90% for all grades (0 to 4). Chondromalacia patellae is diagnosed more accurately by using T1 fat saturation than by using T1 spin-echo images. With a combination of the two techniques, accuracy is 90% to 100%.

Adolescent↗
PubMed1994

Further delineation of the ear, patella, short stature syndrome (Meier-Gorlin syndrome).

Two daughters of phenotypically normal parents are described with severe proportional dwarfism with microcephaly, peculiar craniofacial anomalies, microtia, absent patellae, joint hyperextensibility, and other anomalies. Intrafamilial variability is minimal. This combination of anomalies has many similarities to the six cases previously described with the Ear, Patellae, Short stature syndrome (Meier-Gorlin syndrome), which is distinguished by the triad of microtia, absent patellae and growth retardation. Autosomal recessive inheritance is strongly suggested by the presence of two pairs of affected siblings and the equal sex ratio.

Child, Preschool↗
PubMed1994

Patella baja in anterior cruciate ligament reconstruction of the knee.

Twenty-nine consecutive arthroscopic assisted anterior cruciate ligament (ACL) reconstructions of the knee were retrospectively studied to evaluate the incidence of patella baja and the correlation of the finding with patellofemoral pain after the ligament surgery. The central one third of the patellar ligament was used and positioned isometrically. The patellar ligament defect was sutured closed. The incidence of patellar chondromalacia at the time of surgery was 24%. The incidence of medial femoral condyle chondromalacia was 59%. The incidence of symptoms of patellofemoral pain after surgery was 14%. Patella baja occurred in 76% of the ligament reconstructions. Two knees showed unexplained patellar tendon lengthening. There was no statistical difference in the results between the knees with and without baja. Postoperative symptoms of patellofemoral pain correlated best with chondromalacia of the patella or the medial femoral condyle at the time of the surgical procedure. Use of the central one third of the patellar tendon with closure of the defect does lead to baja; however, the presence of this radiographic finding does not correlate with patellofemoral pain.

Adult↗
PubMed1994

Pinhole scintigraphic sign of chondromalacia patellae in older subjects: a prospective assessment with differential diagnosis.

UNLABELLED: Chondromalacia patellae (CP) is an important cause of anterior knee pain. Two clinical types are known: one that typically affects young subjects and the one that affects older patients. The primary diagnostic approach is radiography reinforced with arthrography. A 99mTc-MDP bone scan is invaluable in the study of bone diseases especially when augmented with pinhole scintigraphy (PS). In this study previously unknown, specific sign of CP demonstrated by PS in six middle-aged and elderly patients is described. METHODS: Noting an increased patellar uptake in a planar spot view, a medial PS scan of the patella was taken to detail the uptake pattern using a 3-mm or 4-mm aperture pinhole collimator. The uptake pattern was analyzed in terms of location, definition, mode, grade and other associated changes, and correlated with radiographic and CT scan alterations. RESULTS: The planar views showed patellar uptake to be diffuse and nonlocalizing in five patients and ill-defined and spotty in the remaining patient. In contrast, PS revealed small, spotty uptake well localized in the central retropatellar facet in all but one patient in whom uptake was segmental. A control PS study of 16 patients with their patellas involved by osteoarthritis (n = 6), rheumatic arthritis (n = 5) and Reiter's syndrome (n = 5) also revealed retropatellar uptake with or without anterior patellar uptake in every patient. The CP with localized osteolysis or osteopenia accumulated tracer intensely, whereas those without showed mild to moderate uptake. CONCLUSION: Spotty tracer uptake occurring exclusively in the central retropatellar facet without other knee joint alteration appears pathognomonic of CP in older patients.

Adult↗
PubMed1993

[Experimental study of tangential osteochondral and chondral fracture of the patella].

It has been reported that trauma is not an only responsible factor for tangential osteochondral fracture (OF) in the patellofemoral joint, but other factors predisposing to OF are also involved in many clinical cases. The present investigator manually dislocated the patella of 25 young rabbits without anesthesia (group 1). In other 25 young rabbits (group 2), dislocation of the patella followed the experimental production of the patellar subluxation which was considered as an etiology of OF. The resulting patellar cartilage changes were compared between these groups of rabbits to clarify the relation between the preceding cartilage change and the development of OF. As a result, the present study confirmed that OF was not caused by mere dislocation of the patella but was induced only when dislocation was superimposed on an existing cartilage change resulting from the patellar subluxation. In treating clinical cases of OF, it is, therefore, important to evaluate cartilageous degeneration thoroughly and clarify its pathologic process.

Animals↗
PubMed1993

Upward fixation of the patella in cattle: 38 cases (1984-1990).

Case records of cattle admitted to 2 university veterinary hospitals during 6 years were evaluated to determine the age, breed, sex, and treatment of cattle with upward fixation of the patella. Affected cattle were compared with those from the respective hospital populations of cattle admitted during the same time. Of 38 cattle with upward fixation of the patella, 34 were treated surgically. Follow-up evaluation was obtained from owners of 28 of the treated cattle. Surgery was successful in eliminating all clinical signs in 25 of the 28 cattle. There was an increased risk of upward fixation of the patella associated with Brahman and Brahman-type cattle, compared with non-Brahman cattle.

Animals↗
PubMed1977

[Recentering of the patella; treatment of choice in lateralised femoropatella arthrosis (author's transl)].

The authors have followed up for than 2 years, 22 cases of lateralised femoro-patella arthrosis treated by recentering of the patella. They confirm the value of this operation and emphasize the necessity of controlling the precise position of the patella during the operation. They also believe that one should avoid, especially if the treated arthrosis is not too advanced, perfect reaxation which may favour progressive narrowing of the joint space, once weight beraring is allowed and which may be the origin of the secondary functional degradation of this series.

Femur↗
PubMed1996

The 'small-patella' syndrome. Hereditary osteodysplasia of the knee, pelvis and foot.

We describe a syndrome combining abnormalities of the pelvis, knee and foot in three related patients with a familial history of small dislocated patellae. The clinical and radiological appearance of the patella and pelvis is consistent with the 'small-patella' syndrome, a rare autosomal dominant disorder. There were also previously unreported deformities affecting the feet.

Adult↗
PubMed1997

Fine mapping of the nail-patella syndrome locus at 9q34.

Nail-patella syndrome (NPS), or onychoosteodysplasia, is an autosomal dominant, pleiotropic disorder characterized by nail dysplasia, absent or hypoplastic patellae, iliac horns, and nephropathy. Previous studies have demonstrated linkage of the nail-patella locus to the ABO and adenylate kinase loci on human chromosome 9q34. As a first step toward isolating the NPS gene, we present linkage analysis with 13 polymorphic markers in five families with a total of 69 affected persons. Two-point linkage analysis with the program MLINK showed tight linkage of NPS and the anonymous markers D9S112 (LOD = 27.0; theta = .00) and D9S315 (LOD = 22.0; theta = .00). Informative recombination events place the NPS locus within a 1-2-cM interval between D9S60 and the adenylate kinase gene (AK1).

Chromosome Mapping↗
PubMed1996

[Nail-patella syndrome: clinico-pathologic characteristics].

The nail-patella syndrome is a hereditary disorder showing an autosomal dominant trait. It is characterized by a series of skeletal disorders and nephropathy. The skeletal defects and the renal involvement might occur separately. The usual clinical presenting syndromes of the nephropathy are asymptomatic proteinuria, microscopic haematuria and sometimes nephrotic syndrome. In a considerable proportion of patients renal failure develops. We summarise the clinico-pathological features of the disease presenting in two children and in a young man. The two children showed heavy microscopic occasionally, macroscopic haematuria, asymptomatic proteinuria and the adult patient had nephrotic syndrome. Nail-patella abnormalities were observed in one child without the involvement of family members. Except for the mother of the other child no urine abnormalities could be demonstrated in the patient's families. The kidney biopsy revealed the characteristic signs of the nail-patella syndrome in different extent: bundles of collagen fibrils in the glomerular basement membrane (GBM). Segmental and thinning of the GBM also occurred in the two children. This defect predisposes to the clinically dominant micro- and macroscopic haematuria. These children's reual function remained stable during the follow-up period of 4-7 years. In the GBM of the third patient small subepithelial electron dense deposits-corresponding to stage I. membranous glomerulonephritis- and extensive collagen deposition was found. After two years follow-up persistent nephrotic syndrome and gradual decline in renal function could be observed.

Adolescent↗