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At least 613 records · Page 34Linked to original sources
PubMed1983

Effect of electrical stimulation to the vastus medialis muscle in a patient with chronically dislocating patellae. A case report.

Electrical stimulation to the vastus medialis muscle of a patient with chronically subluxing patellae prevented dislocation of the left patella during its application. No effect could be demonstrated while the stimulator was off. Other clinicians may, nonetheless, wish to adopt the method described in this article for assessing the efficacy of electrical stimulation on patellar dislocation, both while stimulation is applied and while it is not applied.

Adult↗
PubMed1994

Scintigraphic findings on examination of the multipartite patella.

Bipartite or multipartite patella occurs in approximately 2-3% of the general population. In the setting of trauma, this entity may be confused with a fracture of the patella. The mechanism of injury, clinical symptomatology, and plain film findings are often helpful in distinguishing the two possibilities. However, cases do occur in which a fracture cannot be confidently excluded. This case demonstrates how scintigraphy may provide further clarification in this diagnostic dilemma.

Adult↗
PubMed1996

Osteonecrosis and resorption of the patella after total knee replacement: a case report.

A 54-year-old woman with a history of right total knee replacement had right knee pain and swelling for 6 months. Radiographs of the knee showed significant fragmentation and resorption of the patella consistent with osteonecrosis. Evidence of increased anteroposterior laxity was noted on physical examination. Revision surgery to a posterior stabilized prosthesis with excision of the patellar fragments resulted in a marked improvement in her symptoms and functional capabilities 2 years after surgery. The authors review the blood supply to the patella and how it may be disturbed by knee surgery and speculate that this patient's symptoms may have been worsened by the anteroposterior instability of her prosthesis.

Bone Resorption↗
PubMed1998

Patella height after high tibial osteotomy with internal fixation and early motion.

The purpose of this study was to compare the incidence of patella infera in patients after high tibial osteotomy treated with either postoperative immobilization or internal fixation and early range of motion. A retrospective review of 98 patients with high tibial osteotomy was done at the authors' institution. Thirty-three patients who had secondary procedures such as concomitant ligamentous reconstruction with early motion were excluded. Therefore, 69 knees in 65 patients remained in the study cohort. Group A consisted of 32 patients (34 knees) treated with postoperative immobilization, whereas Group B included 33 patients (35 knees) treated with internal fixation and early motion. The preoperative and postoperative Insall-Salvati index, Blackburne-Peel index, and angular alignment were determined for each group. Between Groups A and B, the differences in the Insall-Salvati index and the Blackburne-Peel index were statistically significant, although the difference in angular correction was not significant. With rigid fixation and early motion the Insall-Salvati index showed that there was less postoperative shortening of the patellar tendon. The relationship of the patella to the remainder of the knee was affected less adversely as evidenced by the Blackburne-Peel index. High tibial osteotomy with internal fixation and early range of motion should result in a better knee and ease the subsequent performance of a total knee arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMed2001

Patella in total knee arthroplasty.

The patella is a reliable guide to the success or failure of a total knee replacement. Patients who do not experience peripatellar symptoms or a patellar complication usually have a successful result. Conversely, peripatellar symptoms or complications usually reflect an underlying problem with surgical technique, component designs, or both. Current designs still do not replicate normal kinematics, and current instrumentation and techniques significantly alter the anatomy of the patellofemoral articulation in a substantial percentage of patients. Reproducing extensor mechanism balance and using components that provide adequate congruency and contact area through a physiologic arc of motion should lead to a successful result with minimal patellar symptoms or complications whether or not the patella is resurfaced. Attempting to achieve normal patellofemoral kinematics and minimize patellar complications has led to a better understanding of total knee arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMed2002

Functional outcome after tibial tubercle transfer for the painful patella alta.

Twenty-five patients with painful patella alta without symptomatic subluxation were identified in a prospective database. All patients had a distal tibial tubercle transfer and preoperative knee arthroscopy. The mean postoperative followup was 2.4 years. These patients were matched with healthy volunteers. Patellofemoral scores using the scoring systems of Kujala et al and Lysholm and Gillquist were collected prospectively. The Short Form-36 health survey and the Western Ontario and McMaster Universities Osteoarthritis Index were used postoperatively. Significant improvement in the patellofemoral scores was documented postoperatively; however, the healthy volunteers had significantly higher patellofemoral scores when compared with the patients who were treated surgically. For the three Short Form-36 survey parameters based on physical health (physical functioning, role physical, and bodily pain), there were no statistically significant differences between the patients and the United States age-matched norms; data are available in the Short Form-36 survey manual. Patients with Grade 2 chondromalacia (fissuring and fragmentation less than 1.25 cm) had significantly better scores in pain and function domains of the Western Ontario and McMaster Universities Osteoarthritis Index compared with patients with Grade 3 (fissuring and fragmentation greater than 1.25 cm) and Grade 4 (erosion down to bone) changes. Distal tibial tubercle transfer is a beneficial procedure for treating patients with painful patella alta.

Activities of Daily Living↗
PubMedDate not supplied

Evaluation of patella position based on radiologic and ultrasonographic examination: comparison of the diagnostic value.

This study compared radiologic and ultrasonographic methods of evaluation of patella position. The radiologic examination was based on the evaluation of Insall and Salvati's index (I-S index), whereas the ultrasonographic examination was based on the determination of analogous coefficient called the patellar tendon-patellar coefficient (T-P coefficient). The total number of examined knee joints was 55 in 30 patients (13 children, aged 7-16 years and 17 adults aged 17-39 years) with knee pain. Considerable differences of the evaluated parameters were observed in the group of examined children: I-S index, 1.50; T-P coefficient, 1.20; and small differences in the group of adults: 1.17 and 1.32, respectively. Those differences resulted from difficulties with interpretation of the apparent radiologic picture of the knee joint with the patella incompletely ossified. The ultrasonographic picture in both children and adults is a real picture, and the possibilities of its interpretation are independent of the degree of patellar ossification.

Adolescent↗
PubMedDate not supplied

Congenital dislocation of the patella. Part II: orthopaedic management.

Five patients (eight knees) with diagnosed congenital dislocation of the patella and well-documented charts were reviewed. Age at diagnosis ranged from 4 days to 6 years. A flexion contracture of the knee and femorotibial rotatory dislocation of varying degrees were present in all the cases. The quadriceps was active in all the cases, producing knee flexion in four cases. Foot deformity was associated in all the cases (clubfoot, calcaneovalgus, or congenital vertical talus). Gradual correction of knee flexion contracture with serial casting was attempted in five cases leading to an almost complete extension in two cases. Treatment of patellar dislocation was surgical in all the cases, consisting in extensive quadriceps release (seven knees) or V-Y lengthening (one knee), division of lateral soft tissues, and reefing of the medial retinaculum and capsule. Intraoperative anomalies were recorded. At an average follow-up of 6.9 years, all the patients are able to walk on their operated limb, and the patella is centered in the trochlea in all the cases. Knee mobility, rotatory dislocation, and daily function were improved in seven cases.

Child↗
PubMedDate not supplied

Imaging of "iliac horns" in nail-patella syndrome.

Hereditary osteo-onychodysplasia, also known as the nail-patella syndrome (NPS), consists of a clinical tetrad of nail dysplasia, hypoplastic or absent patella, radial head dislocation, and iliac horns. Bilateral posterior iliac horns are observed only in NPS and present in >80% of patients. We describe the appearance, location, and structure of iliac horns by CT, MRI, and 3-dimensional CT reconstruction.

Adult↗
PubMed1994

Evaluation of methods of internal fixation of transverse patella fractures: a biomechanical study.

Biomechanical testing was performed to evaluate five techniques of internal fixation of transverse patella fractures. Using cadaveric lower extremities, transverse osteotomies of the patella were performed, and the simulated fractures were fixed with the following techniques: the modified tension band, anterior tension band with a supplemental cerclage wire (the Pyrford technique), tension band with cancellous bone screws, Pyrford technique with cancellous screws, and cancellous screws alone. The fixation techniques were evaluated by measuring the separation of the fracture fragments during loading to produce a physiologic range of motion (90 degrees flexion to full extension). All techniques functioned adequately, with no fracture gap exceeding 1 mm. The tension band with screws technique performed significantly better than did the modified tension band, with an average fracture gap approximately half that of the traditional modified tension band technique. Mechanically, the addition of the screws to the tension band techniques reduces fracture separation by providing compression throughout the range of motion and by resisting the tensile loading during terminal extension.

Aged↗
PubMed1996

Open fractures of the patella.

We retrospectively reviewed 57 open patella fractures treated at our institution between 1976 and 1989. Forty-four patients with 47 fractures (cases) were available for follow-up a mean of 9.4 years after injury (range 2.2-15.7). High-energy vehicular trauma was the cause of injury in > 90% of cases. Treatment included osteosynthesis in 50% of cases and patellectomy (partial or total) in the remainder. At follow-up evaluation, results were excellent in 17% of cases, good in 60%, fair in 17%, and poor in 6%. Nonunion occurred in two cases in which nonrigid internal fixation was used. The incidence of deep infection was 10.7%, and the infection rate correlated with the magnitude of soft-tissue injury. Two of the seven fractures (29%) treated with cerclage wiring became infected. None of the open type I and II fractures treated with immediate internal fixation or primary wound closure (or both) became infected. Therefore, we recommend immediate rigid internal fixation (other than cerclage wiring) of types I and II open patella fractures. Partial patellectomy of highly comminuted fractures provided results similar to those of internal fixation of less comminuted fractures. Thus, when comminution precludes fixation, partial patellectomy can be performed without hesitation. The timing of wound closure should be individualized.

Adolescent↗
PubMedDate not supplied

Biomechanical comparison of fixation methods in transverse patella fractures.

OBJECTIVE: To compare monofilament wire versus braided cable for stabilizing transverse patella fractures using the modified AO tension band technique. DESIGN: A randomized blocked (paired) study comparing two fixation methods. Statistical analysis was performed using a nested repeated measures analysis, followed by Bonferroni post hoc testing. METHODS: Seven paired embalmed knees (mean age 71.8 years, SD 14.6 years) were dissected, and transverse fractures were simulated. The knees were reduced and randomly fixed by either two parallel 0.062-inch Kirschner wires with a 1.0-millimeter-diameter 316L stainless steel monofilament wire tension loop or two Kirschner wires with a 1.0-millimeter-diameter 316L stainless steel braided cable tension loop. Knees were tested by applying a cyclic load through the suprapatellar tendon between twenty and 300 newtons for thirty cycles. RESULTS: The maximum fracture displacement increased with each cycle of loading for both the braided cable and monofilament wire tension loop configurations (p = 0.0001). The average peak displacement at the thirtieth cycle was 2.25 millimeters for monofilament wire and 0.73 millimeters for the cable. When comparing both methods for all cycles, the braided cable allowed less fracture displacement than did the monofilament wire (p = 0.002), and the rate of increase per cycle of maximum fracture displacement was less for the cable than for the wire (p = 0.0001). CONCLUSIONS: In transverse, noncomminuted patella fractures, fixation with two Kirschner wires and a 1.0-millimeter braided cable tension loop was superior to the monofilament wire tension loop. Most importantly, the braided cable afforded more predictable results during cyclic loading.

Aged↗
PubMed1976

Occult traumatic dislocation of the patella.

In series of patients with clinically established traumatic patellar dislocation other authors have found surgical and radiological lesions pathognomonic for this condition. In a series of patients admitted with hemarthrosis, and with no knowledge of having had dislocation of their patella, we found the same lesions thus illustrating that a syndrome of occult traumatic patellar dislocation exists. The vertical location of the patients' patellae was found normal measured by the index of Insall and Salvati (9). The intercondylar groove measured by the method of Brattström (4) was found in almost all cases to be under the upper normal limit. Their knee caps were normal following the descriptions of Knutsson. None had valgus knees beyond normal upper limits and none had general laxity of joints, thus indicating that this syndrome may be found in normal knees.

Adolescent↗
PubMed1985

Acute traumatic dislocations of the patella.

Twenty-three consecutive patients with acute traumatic dislocation of the patella were followed up for a mean period of 39 months. All patients had a medial capsulorrhaphy and in eight cases a supplementary lateral capsulotomy. Dislocation recurred in two cases, one of whom had had a supplementary lateral capsulotomy. Chondromalacia was demonstrated at followup in eight patients, six of whom belonged to the lateral capsulotomy group. We conclude that lateral capsulotomy confers no advantage in the operative repair of acute dislocation of the patella.

Cartilage Diseases↗
PubMed1986

Bilateral rupture of the patella tendon in an otherwise healthy male patient following minor trauma.

A case of bilateral patella tendon rupture in an otherwise healthy 38-year-old man who sustained relatively minor trauma is presented. A flexion moment against a contracted or contracting quadriceps muscle is thought to have been the mechanism of injury. A survey of the literature yielded reports of three other cases of otherwise healthy patients who had had bilateral simultaneous disruption of the patella tendons.

Adult↗
PubMed1999

Intra-articular dislocation of the patella: two cases and literature review.

Intra-articular dislocation of the patella remains uncommon and is generally thought to be a problem of young adolescent males. This report reminds emergency physicians that it can occur in the arthritic knee, and it should be considered in the differential diagnosis of locked knee in the elderly. Closed reduction should be attempted in these cases, because the dislocation is liable to be held in place by osteophytes rather than impaction of the patella deep in the intercondylar notch and a good functional outcome can be expected.

Age Distribution↗