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PubMed2005

Superior dislocation of the patella with early onset patellofemoral arthritis: a case report and literature review.

Among the traumatic patellar dislocations, superior dislocation of patella without patellar ligament injury is very rare. We present in this article, a case of superior dislocation of the patella trapped by interlocked osteophytes in a 38-year-old female who had concurrent bilateral knee arthrosis. Successful reduction was achieved by closed manipulation without anesthesia. Neither redislocation nor symptoms of instability was seen after 36 months of follow-up, although some progression of arthritis was observed. A new classification including all traumatic patellar dislocation was also proposed.

Adult↗

PubMed2001

Patella resurfacing in total knee replacement: functional evaluation and complications.

Three different knee replacements, with three trochlear designs, were prospectively evaluated clinically and radiographically for patellar function and presence of patellar complications. They included the Insall-Burstein (IB) I and the IB-II (posterior cruciate ligament substituting) and the Meniscal Bearing Knee (MBK; posterior cruciate ligament recession). The trochlea of the IB-I was short and shallow with an anterior sharp edge of the intercondylar box (later modified to a smoother edge) and the femoral component had a prominent "shoulder." In the IB-II the trochlea was deeper to allow for soft tissue clearance. In the MBK the trochlea was more prolonged, with R and L components and the "shoulder" was less prominent. In all the cases the patella was resurfaced with an all polyethylene dome prosthesis. Knees with tibiofemoral problems were excluded. From the data of the present study the following conclusions can be drawn: (a) The most frequent problem was impingement (clunks) with the early version of the IB-I. Smoothening of the anterior edge significantly reduced the incidence of clunks to 5% in the modified IB I. (b) With the IB-II deepening the trochlea for soft tissue clearance improved the degree, not the incidence of clunks (4.5%), compared to the modified IB I. (c) With the MBK clunks were very rare and patellar function improved. (d) Throughout the three series patellar stress fractures and instability were rare and loosening or wear not evident. (e) Normal function (including stairs ascending and descending) can be expected in over 80% of category A patients. (f) Of the various radiological parameters only patella baja was correlated with symptoms in the IB prostheses. (g) We still prefer the dome design because is more tolerant and with cold flow may better conform to the trochlea increasing contact area.

Adult↗

PubMed1998

Treatment of deep cartilage defects of the patella with periosteal transplantation.

Twenty-six consecutive patients (19 men and 7 women) with a mean age of 31.5 years (range 19-52 years) who suffered from an isolated full-thickness cartilage defect of the patella (area ranged from 0.75 to 20.0 cm2) and disabling knee pain were treated with autologous periosteal transplantation (without any chondrocytes). The duration of symptoms was 59 months (range 11-144 months). During the first 5 postoperative days all patients were treated with continuous passive motion (CPM). This was followed by active motion, slowly progressive strength training, and slowly progressive weight-bearing. After a mean follow-up of 42 months (range 24-76 months), 17 patients (65%) were graded as excellent (were painfree), 8 patients (31%) as good (had pain with strenuous knee-loading activities), and 1 patient as poor (had pain at rest). Twenty-two patients (85%) had returned to their previous occupation. Twelve patients (46%) had resumed sports or recreational activities at their former level. Repeated magnetic resonance imaging (MRI) investigations showed progressive, and finally complete, filling of the articular defects. Biopsies taken in five randomly selected cases showed hyaline-like cartilage. Patients with full-thickness cartilage defects of the patella and disabling knee pain can be treated with autologous periosteal transplantation (without any chondrocytes), followed by CPM, and slowly progressive strength training and weight-bearing. We believe this is a good method to accomplish regeneration of articular cartilage and satisfactory clinical results.

Adult↗

PubMed1999

Fractures of the patella in children.

Fractures of the patella are relatively rare injuries for children. Fourteen patients with patellar fractures were reviewed. There were 12 boys and two girls with the age ranging between 9 and 15 years and an average of 11.4 years. Sleeve fractures were the most common type of patellar fractures observed (eight cases), followed by transverse fractures (four cases) and comminuted fractures (two cases). All the fractures were treated with open reduction and followed up for 2 to 20 years. Overall results were good in 13 patients, and flexion limitation of the knee was seen in one. Fractures of the patella in children are characterised by sleeve fractures. The prognosis of the patients treated with open reduction is generally good.

Adolescent↗

PubMed1998

Tuberculosis of the patella.

A rare case of tuberculosis of the patella is presented. Diagnostic features include an osteolytic lesion in the patella with flaky sequestrum, associated with typical clinical features. Treatment should be urgent and should include a regimen of surgical debridement along with four antitubercular drugs. Once the joint is involved, the end results become less satisfactory.

Adolescent↗

PubMed2006

Tension-band wiring of transverse fractures of patella. The effect of site of wire twists and orientation of stainless steel wire loop: a biomechanical investigation.

Tension-band wiring is commonly used to treat transverse patella fractures. The most common configuration has parallel Kirschner (K) wires and a stainless steel wire loop placed in a vertically oriented figure of eight. Early mobilisation is important but can cause detrimental displacement at the fracture site. A wooden model of a transversely fractured patella was used to compare different fixation constructs. The fracture was fixed using two K wires and a stainless steel wire loop. One or two wire twists were used, placed either arbitrarily or at corners of the loop. The loop was oriented either vertically or horizontally. Interfragmentary compression at the point of wire breakage and permanent displacement on cyclic loading was measured for each construct. Placement of the figure of eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% (p<0.05, Tukey post hoc test). On cyclic loading, all constructs with vertical figure of eight but none with a horizontal construct failed (p=0.01; Fisher's exact test). Permanent fracture displacement after cyclic loading was 67% lower with horizontal figure of eight constructs (p<0.05; t test). Placing wire twists at the corner and a horizontal placement of figure of eight improves stability of the construct.

Biomechanical Phenomena↗

PubMed1998

Chondroblastoma of the patella with a secondary aneurysmal bone cyst.

A case of chondroblastoma of the patella combined with an aneurysmal bone cyst is presented. Chondroblastoma of the patella is an uncommon, benign neoplasm. On the other hand, secondary aneurysmal bone cyst is frequently associated with giant cell tumour of chondroblastoma.

Adolescent↗

PubMed2006

Steroid-responsive nephrotic syndrome in a patient with nail-patella syndrome.

Nail-patella syndrome (NPS) is a rare disorder with autosomal dominant mode of inheritance. We report a child with NPS and steroid-responsive, frequently relapsing nephrotic syndrome. The child had dystrophic nails, flexion contractures of both elbows and normal renal functions. X-rays of the knees and pelvis showed hypoplastic patellae and iliac horns. Renal histology was unremarkable with mild focal increase in mesangial cellularity compatible with minimal change disease. Ultrastructural features of NPS including thickening of the glomerular basement membrane with electron-lucent areas were not found.

Child↗

PubMed2001

Gouty tophus of the patella evaluated by PET imaging.

We report a case of gouty tophus of the patella, a rare lesion, which was evaluated using positron emission tomography (PET). This modality, which uses a combination of an amino-acid analog emitter, L-[3-(18)F]-alpha-methyl tyrosine (FMT), which neglects malignancies, and a glucose analog emitter, (18)F-fluoro-2-deoxy-D-glucose (FDG), which neglects benign lesions, simulating the radiographic findings, may be useful for the preoperative evaluation of gouty tophus occurring in patella partita, including detection, differentiation from malignant tumors, and possible pathogenetic diagnosis.

Gout↗

PubMed1981

Comminuted displaced fractures of the patella.

A series of 64 comminuted displaced fractures of the patella is reviewed. Morphologically the fractures can be classified into three groups reflecting the mechanism of injury and the degree of soft tissue damage. All fractures were operated on. Tension band wire was used in 21, partial patellectomy in 33 and total patellectomy in patients. The problem of the management of these fractures is often in making the choice between excision and internal fixation. In this retrospective analysis the results of anterior tension band wire fixation were acceptable even in severe comminuted fractures. Partial excision showed satisfactory results provided that at least three-fifths of the patella could be preserved. Total excision is sometimes clearly unavoidable but should be preceded by sober contemplation whenever considered as the alternative to internal fixation.

Adult↗

PubMed1985

Refracture of the patella.

Mildly displaced fractures of the patella, with an intact extensor mechanism, are widely treated in a plaster cylinder. This may lead to disuse osteoporosis of the patella and a subsequent refracture, which may be at a different site. A suggested method of splintage is to use a removable back splint for a period of 1-2 weeks.

Adolescent↗

PubMed1985

Fractured patella: operative treatment using the tension band principle.

The tension band principle was applied in the operative treatment of fractures of the patella in 139 patients, of which 100 were reviewed retrospectively; 61 per cent were males and 70 per cent were aged between 50 and 70. The fractures were treated soon after admission and movement of the knee was started as soon as possible after the operation. Sixty-eight patients were reviewed and 72 per cent were happy with the resulting knee function. Objectively, 81.3 per cent had an excellent or good result. Minor troubles from the operations were common but it was concluded that the wiring of fractured patellas using the tension band principle is a safe and effective technique.

Adult↗

PubMed1989

Techniques for measuring the static and dynamic properties of the patella.

An electrogoniometric method was used together with a new standardized radiographic technique to accurately determine the rotation of the patella during knee flexion of both normal subjects and patients referred for retropatellar pain. A preliminary study using these techniques shows that retropatellar pain is very much a multi-factoral clinical problem and that combinations of patello-femoral articulation abnormalities, patellar shape and mechanical influences are present in all forms of the painful patella.

Adolescent↗

PubMed1988

Functional restoration of an articular surface using a heterotopic xenograft: biology of host-implant interactions in the canine patella.

Glutaraldehyde-treated bovine meniscal fibrocartilage has been used as a heterotopic bioprosthesis to repair large osteochondral defects in the canine patella. An efficient, functional articulating surface was reformed and the graft did not elicit a significant immunological response. Although tissue bonding between the host and graft was often excellent, the implant did not become revascularized or replaced by host tissue but acted as an inert space occupier. This material may offer some potential for conservative treatment of articular defects in the patella in appropriate circumstances.

Animals↗

PubMed1992

Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report.

We present a surgical technique for the treatment of recurring dislocation of the patella. The procedure, based on Galleazzi's tenodesis of the semitendinosus, uses minimal dissection and small incisions to improve cosmetic results and speed recovery. A polyester ligament is passed through a bone tunnel at the midline of the patella and fixed at the medial condyle, thus creating a medial patellofemoral neoligament. We have reviewed the results of 30 knees in 30 patients with an average follow-up of 39 months. Twenty-five patients (83.3%) showed significant improvement of their initial complaints.

Adolescent↗

PubMed1992

Cystic degeneration of the patella after arthroscopic chondroplasty and subchondral bone perforation.

Chondromalacia of the patella is frequently encountered in patients with anterior knee pain. Arthroscopic chondroplasty with perforation of subchondral bone remains a popular treatment alternative in spite of the inferior mechanical properties of the fibrocartilaginous tissue that this procedure is designed to promote. We report a case of cystic degeneration of the patella as a previously unrecognized complication following the procedure.

Adult↗

PubMed1995

Arthroscopic proximal patella realignment and stabilization.

Treatment of patellofemoral pain is a source of much controversy. This is shown by the vast number of surgical procedures used in treatment. This article describes an arthroscopic proximal realignment technique to address patellafemoral pain and instability. We have used this technique to treat acute dislocations with capsular deficits, recurrent dislocations, and subluxations. This procedure was developed in 1988 as an alternative treatment to distal realignment in a 10-year-old child with recurrent dislocation of the patella. In adults, we have used this technique in conjunction with a lateral release and in two cases with a distal realignment procedure. Our experience is that low technical demand, consistency of results, low morbidity, and cosmesis make this a worthwhile technique. We believe that this procedure is a valuable technique either alone or in conjunction with other procedures in the treatment of patella maltracking and instability.

Adult↗

PubMed1996

Adaptation of bone to altered loading environment: a biomechanical approach using X-ray absorptiometric data from the patella of a young woman.

Loading induced changes in the bone mineral apparent density (BMAD) and average strain magnitude (strain index) of the patella were estimated using a novel analytic method of dual energy X-ray absorptiometric (DXA) and isometric strength data obtained from repeated measurements of a 26-year-old woman. The strain index was used as a major determinant of bone adaptation to physical loading. The subject's lower limb skeleton was measured 12 times during a 3-year period including a 1-year unilateral strength training intervention, an accidental knee ligament rupture, and a 2-year rehabilitation period. Instead of standard DXA analysis, the patella, a bone practically affected by quadriceps activity only, was analyzed in terms of estimated loading induced stresses and strains. The mechanical stress is directly proportional to the effective force and inversely proportional to the area over which the given force is applied. The strain, in turn, is proportional to the given stress divided by the bone stiffness, which was assumed to be proportional to BMAD. The effective force, the contact area, and the BMAD were estimated from the muscle strength and DXA data, respectively. In addition, post-traumatic bone loss and subsequent recovery with time were assessed using an exponential model. The loading during the 1-year training period increased the average patellar strain index by 47% and did not affect the patellar BMAD. Immediately after the injury, the apparent inability to do muscle work drastically reduced the strain index and likely initiated the patellar bone loss, a loss which continued for about 4 months. During rehabilitation, the imbalance between the patellar stiffness and increased functional stress (muscular performance) became sufficiently large to level off the bone loss and stimulate bone gain. At that time, the strain index indicated that the patellar deformation more than doubled (135%) as compared to baseline level. Accordingly, the BMAD increased until an apparent balance between BMAD and the muscular strength was achieved by the 3-year end point. The exponential models explained well both the post-traumatic bone loss (R2 = 0.89) and bone gain during recovery (R2 = 0.98). In conclusion, the present observations support the concept of the nonlinear nature of the skeletal response to mechanical loading and suggest a potential utility of muscle strength measurements and DXA information for improved understanding of the effects of training, immobilization and remobilization on bone tissue.

Absorptiometry, Photon↗