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PubMedDate not supplied

Anterior knee pain in children with cerebral palsy.

Anterior knee pain arising from the patellofemoral joint may be a significant problem in the cerebral palsy (CP) population. The aim of this study was to classify patients with anterior knee pain based on etiology and organize orthopaedic management based on this classification. This study was a retrospective chart review of patients with CP and anterior knee pain admitted to the orthopaedic outpatient clinic between 1991 and 2003. Children with CP who had intractable anterior knee pain despite 6 months of conservative treatment with at least 2 years' follow-up were identified and included. The medical records, radiographs, and treatment protocols were screened. Patients were classified into 3 groups according to pathology. Group I consisted of 7 children with patella alta only. Group II consisted of 7 children with patellar inferior pole fractures. Group III consisted of 13 children with subluxated or dislocated patellas. Conservative treatment methods such as anti-inflammatory drugs, local ice packs, stretching exercises, and braces should be the first step in treatment. For those patients in whom conservative treatment was not effective, surgical treatment alternatives were discussed. Knee pain resolved in all patients after surgical treatment of the underlying pathology. Gait analysis can be performed for patients with patellofemoral subluxations to evaluate the rotational malalignment of the tibia and femur. In conclusion, anterior knee pain arising from the patellofemoral joint in patients with CP should be evaluated and treated to prevent future functional deterioration.

Adolescent↗
PubMedDate not supplied

Correction of patellar luxation by recession sulcoplasty in three foals.

Lateral luxation of the patella in four femoropatellar joints of three foals was repaired by recession sulcoplasty and medial imbrication of the joint. One foal was euthanatized because of septic arthritis caused by incisional dehiscence, and the other two foals were normal 2 years after surgery. Recession sulcoplasty combined with medial imbrication of the joint capsule resulted in a functional femoropatellar joint and should be considered in foals affected with lateral patellar luxation.

Animals↗
PubMed1995

Simultaneous avulsion of patellar apexes bilaterally in a hemodialysis patient.

A case of simultaneous bilateral avulsion of the patellar apexes is reported. Plain radiography showed bilateral patella alta, but MR imaging was diagnostic. Weakness of the tendo-osseous junction due to secondary hyperparathyroidism and additional chronic inflammatory changes due to repeated microtrauma were considered to be the cause of the rupture.

Adult↗
PubMedDate not supplied

Progressive bone and joint abnormalities of the spine and lower extremities in cerebral palsy.

Bone and joint changes in cerebral palsy result from muscle spasticity and contracture. The spine and the joints of the lower extremity are most commonly affected. Scoliosis may progress rapidly and may continue after skeletal maturity. Increased thoracic kyphosis and lumbar lordosis, spondylolisthesis, spondylolysis, and pelvic obliquity may accompany the scoliosis. Progressive hip flexion and adduction lead to windswept deformity, increased femoral anteversion, apparent coxa valga, subluxation, deformity of the femoral head, hip dislocation, and formation of a pseudoacetabulum. In the knee, flexion contracture, patella alta, and patellar fragmentation are the most commonly seen abnormalities. Recurvatum deformity can also develop in the knee secondary to contracture of the rectus femoris muscle. Progressive equinovalgus and equinovarus of the foot and ankle are associated with rocker-bottom deformity and subluxation of the talonavicular joint. Early recognition of progressive deformity in patients with cerebral palsy allows timely treatment and prevention of irreversible change.

Cerebral Palsy↗
PubMed2003

Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results.

Patellar resurfacing in total knee arthroplasty is a topic debated in the literature. Concerns include fracture, dislocation, loosening, and extensor mechanism injury. Residual anterior knee pain has been reported when the patella is not resurfaced. One hundred patients with osteoarthritic knees were prospectively randomized to either have their patella resurfaced or left not resurfaced. All patients were treated with a single prosthesis that featured an anatomically designed patellofemoral articulation (Anatomic Medullary Knee, DePuy, Warsaw, IN) Two patients in the unresurfaced group and one in the resurfaced group required repeat surgery for patellofemoral complications. At 8- to 10-year follow-up evaluations, Knee Society Clinical Ratings scores were not different between the 2 groups. Rates of anterior knee pain with walking and stair climbing were significantly less in the resurfaced group. Eighty percent of patients with a resurfaced patella were extremely satisfied with their total knee arthroplasty versus 48% without patellar resurfacing. When satisfied and extremely satisfied patients were grouped together, there was no difference between the 2 groups.

Aged↗
PubMed1996

Rotatory intra-articular dislocation of the patella in two dogs.

Two young (8 and 13 week old) dogs were referred for evaluation of acute lameness. Physical examination, radiography, and surgical exploration of their stifles confirmed rotatory intra-articular dislocations of the patella. The dislocated patellas were stabilized with wire into their anatomically correct positions and allowed to heal. Follow-up radiography revealed patellar elongation attributable to excessive peripatellar mineralization. Patellar orientation, as evident on radiographs obtained after trauma, may indicate whether closed or open reduction of these injuries is necessary.

Animals↗
PubMed1981

Restoration of dynamic stability of the patella by pes anserinus transposition. A new approach.

Lateral instability of the patella was found after recurrent, habitual and permanent dislocations. Contracture of soft tissues lateral to the patella only occurred with habitual and permanent dislocations, but medial laxity was present in all cases. After adequate release of the lateral contracture, the medial stability was improved by transposition of the lower three-quarters of the pes anserinus to the medial border of the patella, and the patellar ligament. This created a relatively unstretchable physiological sling which ensured dynamic stability of the patella. Six recurrent, 21 habitual and nine permanent dislocations of the patella were treated by this method. Results were excellent in 21 patients, good in 13 and fair in two. The follow-up period varied from 21 to 84 months. There have been no recurrences to date.

Adolescent↗
PubMed2005

Bilateral recurrent discloation of the patella associated with below knee amputation: a case report.

BACKGROUND: Recurrent dislocation of the patella in patients with below knee amputation is a known entity. Abnormally high-riding patella (patella alta) and medial patellofemoral ligament insufficiency in these patients predisposes them to patellar instability. The established treatment of this problem is surgical realignment. CASE PRESENTATION: A 25 year old male patient with bilateral below knee amputation presented with bilateral recurrent dislocation of the patella while walking on knees on uneven ground. Clinical and radiographic studies showed patella alta. A simple shoe modification was used to treat this patient. CONCLUSIONS: A simple shoe modification can be used to treat such a condition which is otherwise treated surgically.

Adult↗
PubMed1985

Combined intra-articular and extra-articular reconstructions for anterior tibial subluxation.

This article describes several procedures that combine intra-articular techniques with extra-articular techniques to stabilize the knee with anterior tibial subluxation. The procedures detailed are reconstruction using the semitendinosus tendon and the iliotibial tract; tenodesis using a strip of iliotibial tract combined with intra-articular reconstruction of the anterior cruciate ligament with the central third of the patellar tendon; "mini-reconstruction"; and a procedure utilizing a vascularized patellar tendon graft plus "dynamic" augmentation.

Humans↗
PubMedDate not supplied

Polycentric total knee arthroplasty: a prognostic assessment.

Polycentric total knee arthroplasty has been performed at the Mayo Clinic on more than 1,600 knees since July 1970. Two groups of 106 and 101 knee arthroplasties performed between July 1970 and July 1971 and June 1971 and January 1972, respectively, were compared at 5 and 7 years. The technique used exposed the joint to methacrylate particles, yet, despite this, wear did not prove to be a problem. Failures occurred because of infection, loosening of the tibial components, settling of the tibial components, subluxation or dislocation, ligamentous laxity, progression of patellofemoral arthritis, and persistence of pain. We did not encounter patellar problems in our patients with osteoarthritis. In the first group with 106 knees, 45 patients with 58 rheumatoid knees survived 7 years; 79% of knees had good results at 5 years and 72% had good results at 7 years. Twenty-one patients with 28 osteoarthritic knees survived 7 years; 75% of knees had good results at 5 years and 61% had good results at 7 years. In group 2 with 101 knees, 43 patients with 64 rheumatoid knees survived 7 years. The results were good in 83% at 5 years and in 64% at 7 years. Among the 20 patients with osteoarthritic knees who survived 7 years, 92% of knees had good results at 5 years and 62.5% had good results at 7 years. This figure is somewhat misleading because 7 patients were lost to follow up in group 2 after 5 years. There is still a need for a well-tolerated resurfacing procedure by means of a nonconstrained prosthesis.

Arthritis↗
PubMed1995

[Patellar subluxation: where are we in 1995?].

In 1995 orthopedic surgeons cope daily with problems related to patellofemoral pathology. The lack of a true relation between the anomalies and the clinical signs is only one of the misleading factors. In spite of the abundant literature on the subject, misunderstanding remains the rule, starting with lack of consensus about the value of words and what they mean. Solutions will come only from a rigorous and scientific approach, in which imaging techniques will probably play a major role. This will be the only way to get rid of one of the last important myths of knee pathology: "the patellar pain syndrome".

Arthrography↗
PubMed1983

Diagnosis of patellofemoral malalignment by computed tomography.

Conventional radiographic assessment of the patellofemoral joint (PFJ) is often unsatisfactory for a variety of technical and theoretical reasons. Using a simple device designed to allow easy and reproducible control of knee flexion, we used computed tomography (CT) to evaluate the PFJ in 10 normal volunteers and five patients with a history suggestive of recurrent subluxation or dislocation of the PFJ. At full extension of the knee the patients with a history of malalignment showed an abnormal patellar centralization and tilt compared with those of the normal volunteers. The abnormalities were absent or less pronounced on images obtained at 20 and 45 degrees of knee flexion.

Humans↗