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At least 649 records · Page 36Linked to original sources
PubMed1992

Clinical and radiographic features, treatment and outcome in 15 horses with fracture of the medial aspect of the patella.

A sagittal fracture of the medial aspect of the patella was identified in 15 horses, 2 of which had been kicked and 12 of which had hit a fixed fence while jumping. Eight horses showed concurrent fragmentation of the base of the patella, and 2 had sustained a concurrent fracture of the distal end of the lateral trochlear ridge of the femur. A cranioproximal-craniodistal oblique radiographic view was essential to identify the site of the medial patellar fracture and to determine its configuration. Fourteen horses were treated by surgical removal of the medial patellar fracture fragment(s). Of 12 horses (83%) without evidence of pre-existing degenerative joint disease, 10 were treated successfully with return to full athletic function.

Animals↗
PubMed1999

In vivo tracking of the human patella using cine phase contrast magnetic resonance imaging.

Improper patellar tracking is often considered to be the cause of patellar-femoral pain. Unfortunately, our knowledge of patellar-femoral-tibial (knee) joint kinematics is severely limited due to a lack of three-dimensional, noninvasive, in vivo measurement techniques. This study presents the first large-scale, dynamic, three-dimensional, noninvasive, in vivo study of nonimpaired knee joint kinematics during volitional leg extensions. Cine-phase contrast magnetic resonance imaging was used to measure the velocity profiles of the patella, femur, and tibia in 18 unimpaired knees during leg extensions, resisted by a 34 N weight. Bone displacements were calculated through integration and then converted into three-dimensional orientation angles. We found that the patella displaced laterally, superiorly, and anteriorly as the knee extended. Further, patellar flexion lagged knee flexion, patellar tilt was variable, and patellar rotation was fairly constant throughout extension.

Adult↗
PubMed1977

Pain in the knee associated with osteoporosis of the patella.

Four patients, all of whom complained of pain in the knee, were found to have radiological evidence of osteoporosis particularly marked in the patella. In 3 a neurological lesion at the appropriate spinal segment was present, and the fourth patient, who was frankly hysterical, had an autonomic disturbance. If radiological porosis is isolated to the patella a distant cause such as nerve irritation should be sought.

Adult↗
PubMed2006

Nail-patella syndrome and its association with glaucoma: a review of eight families.

BACKGROUND: Nail-patella syndrome (NPS) is a rare autosomal dominant syndrome, characterised by dysplasia of the nails, patellae, elbows and iliac horns. Mutations in the LMX1B gene were found in four North American families in whom glaucoma cosegregated with NPS. AIMS: To investigate the association of glaucoma with NPS in Australian families and to determine how common NPS is in Australia. METHODS: One family with NPS and glaucoma was identified from the Glaucoma Inheritance Study in Tasmania. A further 18 index cases of NPS were identified from the genetics database for southeastern Australia. Eight of these pedigrees were available for comprehensive glaucoma examination on available family members. DNA was sequenced for mutations in LMX1B. RESULTS: In total, 52 living cases of NPS were identified suggesting a minimum prevalence of at least 1 in 100 000. 32 subjects from eight NPS pedigrees (four familial and four sporadic cases) were examined. 14 subjects had NPS alone. 4 subjects had NPS and glaucoma or ocular hypertension. Five pedigrees with NPS had a reported family history of glaucoma, although some of these people with glaucoma did not have NPS. LMX1B mutations were identified in 5 of the 8 index cases-three sporadic and two familial. Two of the six (33%) participants over 40 years of age had developed glaucoma, showing increased risk of glaucoma in NPS. CONCLUSION: Patients with NPS should be examined regularly for glaucoma. However, because the families with NPS are ascertained primarily from young probands or probands who are isolated cases, the exact level of risk is unclear.

Adolescent↗
PubMed1985

Avulsion fracture involving the body of the patella.

A report on an unusual transverse fracture through the body of the patella in a 13 year old high jumper is presented. The clinic features and treatment of the more usual avulsion injury of the patella is discussed.

Adolescent↗
PubMed2003

Superior dislocation of the patella; a case report and review of the literature.

Superior dislocation of the patella is a rare diagnosis. A 72 year old woman attended the accident and emergency department of the hospital with a painful right knee after a knock to the knee. Clinical examination and radiographs confirmed a superior dislocation of the patella, which was reduced and closed with the aid of simple analgesia. The authors present the case report and discuss the relevant literature.

Aged↗
PubMed1979

Dorsal defect of the patella (DDP): a characteristic radiographic lesion.

The dorsal defect of the patella (DDP) is a benign lesion with specific radiographic features. Seven cases of DDP are reviewed; all 7 lesions were identical in location and radiographic appearance. The characteristic lesion is round and lytic, with well-defined margins; it is located in the superolateral aspect of the patella adjacent to the subchondral bone. Arthrography reveals intact cartilage. DDP may occur in both sexes and may be bilateral. It is often found incidentally on radiographs ordered for acute trauma. Its etiology is not known. Differential diagnosis is also discussed.

Adolescent↗
PubMed1993

Synovial plicae and chondromalacia patellae: correlation of results of CT arthrography with results of arthroscopy.

The purpose of this study was to compare computed tomographic (CT) arthrography with arthroscopy in the evaluation of patients with anterior knee pain. The authors studied 23 patients with patellar plicae at CT arthrography. Twenty of 21 patients presumed to have medial plicae at arthroscopy had similar findings at CT arthrography (sensitivity, 95%; specificity, 100%). However, 10 of 12 suprapatellar plicae and 11 of 11 lateral plicae seen at CT arthrography were not seen at arthroscopy. All 11 patients with a diagnosis of no or mild chondromalacia patellae at arthroscopy had similar CT arthrographic findings, whereas seven of 11 patients presumed to have moderate or severe chondromalacia patellae at arthroscopy had matching CT arthrographic results (sensitivity, 100%; specificity, 73%). CT arthrography was much more accurate in classifying plicae as thick (66%) as opposed to classifying plicae as thin (17%). The authors conclude that CT arthrography is an accurate and specific modality for distinguishing patients with anterior knee pain due to plicae from those with anterior knee pain due to differing causes.

Adult↗
PubMed2006

Missing creases of distal finger joints as a diagnostic clue of nail-patella syndrome.

Nail-patella syndrome (NPS, OMIM 161200) is an autosomal dominant disorder with a clinical characteristic tetrad consisting of fingernail dysplasia, hypoplastic or absent patellae, bony protuberances of the ilia (iliac horns) and dislocation of the radial head. Kidney involvement may lead to renal failure, and there is an increased risk for glaucoma. Clinical diagnostic skin clues are triangular lunulae especially on the thumbs which are highly predictive for the NPS. A less known but even more important sign is the absence of skin creases on the dorsal aspects of the distal interphalangeal joints. Even in patients with normal nails the absence of distal interphalangeal creases was noted. Less specific skin changes are webbing between digits, within the popliteal fossae, hyperextensible joints, absent or fragile nails and grooved nails and longitudinal ridging with splitting. With increasing costs in the health care system, it is important to recognize diseases by specific clinical findings which are often as predictive and precise as expensive technical investigations.

Adult↗
PubMedDate not supplied

Medial subluxation of the patella as a complication of lateral retinacular release.

We examined 54 patients (60 knees) referred to us because of their failure to improve, or because of a worsening of their preoperative symptoms, following an arthroscopic lateral retinacular release. Thirty knees developed medial subluxation of the patella postoperatively. This disabling condition is new to us. It is previously unreported as a complication of arthroscopic lateral retinacular release. Anterior knee pain was the only reported preoperative symptom in 14 knees. Sixteen knees had a preoperative diagnosis of lateral patellar subluxation on the basis of a positive apprehension sign only. Eighteen of 30 knees had no surgery of the extensor mechanism other than the arthroscopic lateral release. The remainder additionally underwent varying types and numbers of operations in an attempt to resolve their disability. CAT scan evaluation of three patients who volunteered for the procedure demonstrated severe atrophy and retraction of the vastus lateralis. Loss of this dynamic lateral stabilizer contributed to the medial subluxation of the patella.

Adolescent↗
PubMedDate not supplied

Surgical correction of medial subluxation of the patella.

We evaluated the results of a surgical procedure to correct medial subluxation of the patella in 63 patients (65 knees), most of whom had undergone a lateral retinacular release. We performed a direct repair or a reconstruction of the lateral patellotibial ligament using locally available tissue such as strips of iliotibial band or patellar tendon. Followup averaged 53.7 months (range, 24 to 99). Outcome was based on the examiner's inability to clinically reproduce the patient's painful medial subluxation and on the patient's general impression of his or her improved functional status. Forty-four patients (68%) reported improvement in their functional levels and 49 (75%) reported that they were subjectively improved by the procedure. Overall, 50 patients (80%) had a rating of good or excellent. Six knees required a second surgical reconstruction because of failure to improve or because of a reinjury. Analysis of overall clinical outcome revealed no significant relationships based on the patient's age at the time of the initial procedure, sex, or length of followup (P > 0.10). Reconstitution of the lateral patellotibial ligament effectively corrected medial subluxation of the patella and long-term results of this salvage procedure were satisfactory.

Adolescent↗
PubMed2005

Tophaceous gout in the bipartite patella with intra-osseous and intra-articular lesions: a case report.

We report a case of a 34-year-old man who had an acute gouty attack with tophi around the accessory bone of the bipartite patella with intra-osseous lesions. As the symptoms did not respond to conservative treatments, the patient was treated surgically. Arthroscopy revealed urate crystals surrounded by inflammatory synovitis on the surface of the bipartite patella. Arthrotomy exposed the abundant crystals around the accessory bone and in the intra-osseous lesion. These findings made us speculate that some pre-existing inflammatory conditions around the accessory bone induced deposition of urate crystals, and the destruction of the barrier between the deposits and the joint led to an acute arthritis. Curettage of the tophi resulted in immediate improvement of knee function. There had been no recurrence of symptoms at the 2-year follow-up.

Adult↗
PubMed2005

Functional characterization of LMX1B mutations associated with nail-patella syndrome.

Nail-patella syndrome (NPS) is an autosomal dominant disease characterized by dysplastic nails, absent or hypoplastic patellae, elbow dysplasia, and nephropathy. Recently, it was shown that NPS is the result of heterozygous mutations in the LIM-homeodomain gene, LMX1B. Subsequently, many mutations of the LMX1B gene have been reported in NPS patients. However, functional analyses of the mutant proteins have been performed in only a few mutations. Furthermore, the mechanisms of dominant inheritance in humans have not been established. In the present study, we analyzed the LMX1B gene in three Japanese patients with NPS and identified two novel mutations, 6 nucleotide deletion (Delta246N 247Q) and V242L. These two mutations are located in the homeodomain of LMX1B. Functional analyses of the LMX1B mutants revealed that these mutants had diminished transcriptional activity and had lost DNA binding ability. Furthermore, we demonstrated that each mutant did not manifest a dominant-negative effect on the transcriptional activity of wild-type LMX1B. These results suggested that NPS is caused by loss-of-function mutations of LMX1B, and haploinsufficiency of LMX1B should be the predominant pathogenesis of NPS in humans.

Adolescent↗
PubMed1992

Subluxation of the patella: evaluation of patellar articular cartilage with MR imaging.

In patients with subluxation of the patella, injury of the patellar articular cartilage is frequently observed, and correct evaluation of this cartilage injury is extremely important for the management of these patients. Magnetic Resonance (MR) studies were performed on 102 patellofemoral (PF) joints of 51 patients with subluxation of the patella and 20 PF joints of 10 healthy volunteers. In 77 of the 102 PF joints with subluxation, arthroscopy and/or operation were performed. MR images were obtained with spin-echo and FLASH sequences, and para-axial images were obtained. We retrospectively analysed the MR findings of the 77 joints with special attention to the surface and thickness of the cartilage, and classified them into four grades. These MR grades were compared with the grades on arthroscopy, and the following results were obtained: MR grade 0, normal cartilage (n = 27, sensitivity 90.9%, specificity 74.2%); MR grade 1, thickening of the cartilage (n = 24, sensitivity 50%, specificity 89.1%); MR grade 2, surface irregularity of the cartilage (n = 20, sensitivity 85%, specificity 94.7%); MR grade 3, loss of the cartilage (n = 6, sensitivity 100%, specificity 100%). Although the early changes observed by arthroscopy were underestimated from the MR images, MR imaging proved to be extremely useful for evaluating moderately or advanced patellar cartilage injury.

Adolescent↗
PubMed1976

Patello-femoral joint mechanics and pathology. 2. Chondromalacia patellae.

Two distinct lesions affect the articular cartilage of the patella. Surface degeneration occurs particularly on the odd facet; it is age dependent, often present in youth and it becomes more frequent with increasing age. It probably does not occasion patello-femoral pain in youth, but may predispose to degenerative arthritis in that joint in later years and is regarded as a consequence of habitual disuse. The term "basal degeneration" is used to describe a lesion in which there is a fasciculation of collagen in the middle and deep zones of cartilage without, at first, affecting the surface. It was found astride the ridge separating the medial from the odd facet in twenty-three adolescents who had complained of prolonged patello-femoral pain. They were treated by excision of the disc of affected cartilage, with relief of pain in most cases. The pathogenesis of basal degeneration is related to the functional anatomy of the patella.

Adolescent↗
PubMed1977

Osteochondritis dissecans patellae.

Six cases of osteochondritis dissecans patellae have been studied in five patients in an attempt to clarify the aetiology and prognosis. Assessment of the results of treatment was performed using a standard protocol. The thirty-four previous case reports in the literature are reviewed. In four of the five patients symptoms began after flexing the knee under load and three showed patellar subluxation on tangential radiographs. Thus, repetitive shearing stress on the patellar surface is thought to be an important aetiological factor. The indication for operation is a loose osteochondral fragment either wholly or partly detached from the articular surface of the patella. Vertical excision of the affected area of articular cartilage with drilling of the underlying bone gave two "good" and two "excellent" results. Healing of the drilled area and maintenance of the cartilage space was seen in radiographs of all four cases so treated. This simple method of treatment, which probably causes filling of the defect in the surface by fibrocartilage, is recommended.

Adolescent↗
PubMed1978

Is chondromalacia patellae a separate clinical entity?

The articular cartilage of the patella was studied in 100 knees at necropsy. In twenty-one of these knees the cartilage changes were related to the trabecular architecture of the underlying bone. It would appear that the initiation and location of cartilage damage and its rate and degree of progression are related to the relative stiffness of the underlying cancellous bone. On the basis of our observations we suggest that the diagnosis "chondromalacia of the patella" should be reserved for patients with asymptomatic or transiently symptomatic fibrillation of the articular cartilage of the central medial patellar facet. Those patients with persistent patellofemoral pain should be considered to have some other syndrome.

Cartilage Diseases↗
PubMed1979

The "small patella" syndrome.

Twelve closely related members of one family were found to have small or absent patellae. Seven of these patients also had abnormalities of the pelvic girdle and upper femora. There was a resemblance to the nail--patella syndrome in the patellar abnormalities but not in the associated conditions, and it would therefore appear that the syndrome described is a new variety of congenital abnormality of the knee.

Adolescent↗