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A 20-year-old man presented to our clinic with pain and swelling in the right knee of one year's duration. Biopsy of the patella revealed an aneurysmal bone cyst secondary to a giant cell tumor. He was treated by curettage and bone cement to fill the defect. The rarity of this lesion in the patella and its treatment modalities are discussed.
The authors reported a case of recurrent dislocation of the patella associated with Down's syndrome. As for treatment, it is important to consider the levels of intelligence and daily activity, severe obesity, and certain internal medical conditions associated with this disease. Primary orthotic treatment is recommended for subluxation or reducible dislocation of the patella.
A series of 45 patients with chondromalacia patellae demonstrated clinically and by arthrotomy, but without demonstrable biomechanical misalignment, was investigated retrospectively. Thirty-one of the patients had only been treated conservatively while partial chondrectomy was performed in 14. All of the patients underwent an intensive rehabilitation program. After 12 years the patients were interviewed. Eighty-one percent of the patients who were treated conservatively and 57 percent of the patients in whom partial chondrectomy was performed had mild or no pain and no other knee complaints. The results were better for patients aged 20 years or younger. Two patients received disability pensions on account of poor knee function and 6 had changed to less strenuous occupations. Restraint is advised as regards operative treatment of chondromalacia patellae.
The clinical presentation of 26 knees in 25 children with habitual dislocation of the patella caused by contracture of the quadriceps muscle was studied. They had all received intramuscular injections to the thigh during infancy. The predominant symptom was sudden giving way of the knee during activity. The patella dislocated everytime the knee flexed and when allowed to do so, full flexion was possible; when it was prevented from dislocating, knee flexion was limited in all cases. At operation, it was noted that the contractures were confined to the iliotibial band, vastus lateralis and the lateral fibres of the rectus femoris muscle. Division of the contracted bands corrected the dislocation. In four cases, medial plication was required as an additional procedure. A post-operative extensor lag of the knee was present in all cases, which recovered within one year.
48 cases of fractured patella treated by embracing ring device from 1976-1988 were reported. Among the group, there were 31 males and 17 females, aged 20-80 years. The types of fractures were transverse 28 cases, comminuted 8 cases, fissure or stellate 12 cases; closed 43 cases, opened 5 cases. The methods were adopted, namely: (1) Simple immobilization with embracing ring device. (2) Cylinder plaster cast combined with embracing ring device. (3) Open-reduction with internal fixation combined with embracing ring device. According to the holistic concept the authors adopted both external and topical application of paste to relieve local swelling and oral administration of traditional Chinese medicine. After bone-union the embracing ring device was removed in conjunction with external lotion and active exercises. The 48 cases were followed up ranging from 5 months to 6 years. Satisfactory results were obtained in 41 cases (85.42%). Finally the authors emphasized that the preservation of patella plays an important role in maintaining the extensor mechanism of the knee from physiological and biomechanic views, if the articular surface can be perfectly restored. The nature of embracing ring device and related problems were also discussed.
The author describes a technique for evaluation of the height of the patella: it compares the distance between the lower border of the articular surface of the patella and the antero-superior border of the tibia with the length of the patellar articular cartilage.
In a case report the rare nail-patella-syndrome is presented. Typical and pathognomonic signs are: nail aplasia or dystrophy, iliac horns, hypoplasia or aplasia of the patellae, elbow dysplasia and a nephropathy with electron microscopic demonstrable collagen-like deposition in the glomerular basal membrane. The clinical relevance is determined by the course of the renal disease.
Benign osteoblastoma is a rare tumor; the majority of lesions occur in the spine, femur, and tibia. Osteoblastoma in the patella is so rare that it seems not to have been reported previously in more than one case. A 29-year-old man with a sports injury, who failed to respond to conservative treatment over a prolonged period of time, was later found to have an osteoblastoma of the patella.
We report on the case of a 36 year-old woman with nail-patella syndrome that was detected following a plain roentgenogram of the abdomen showing iliac horns. The nail-patella syndrome (NPS) is a hereditary disorder of tissues of ectodermal and mesodermal origin transmitted as an autosomal-dominant trait. Complete NPS is characterised by a series of skeletal disorders and specific nephropathy; in the recent years some other diseases associated with NPS were described, whereas many patients exist with incomplete NPS.
Thirty-five patients who had rheumatoid arthritis of both knees, but no gross deformity of the patella, had bilateral total knee arthroplasty. In each patient, one knee had a patellar replacement and the other did not. All of the patients were followed for a minimum of two years. The results were the same in both knees in terms of relief of pain and improvement in function, arc of motion, and muscle power. Although no complications that were related to patellar replacement developed in these patients, routine replacement of patellae that have little or no deformity does not seem advisable.
The results in thirty-six knees that had a fracture of the patella after a total condylar arthroplasty were reviewed, and were analyzed according to the type of fracture and the alignment of the implant and the limb. Most of the fractures occurred two years or less after the initial operation. Fourteen knees were rated fair or poor and twenty-two, good or excellent. None of the thirty-six implants had been aligned in the neutral range. In sixteen knees, the alignment had a minor variation from the neutral range--that is, the knees were in minor malalignment. In general, these knees had the least severe fractures and the best over-all results. All had a good or excellent result except one, which was revised because of a loose patellar component. That knee was rated as fair at the latest follow-up. There was a major discrepancy in the alignment of twenty implants. These knees had more severe fractures and less satisfactory results than those in the other group. In two of these knees, the fracture was treated non-operatively; one had a good and the other, a poor result. Twelve of the remaining knees, which were treated surgically, were rated as fair or worse. Two knees that had revision of three components and restoration of alignment to the neutral range had an excellent result. The results of this study indicate that the alignment and fit of a component are important in determining the severity of a fracture of the patella after condylar total knee replacement and the long-term results after treatment of the fracture.
Proximal realignment with standard lateral retinacular release (Insall operation) was performed on 35 knees with a follow-up time of two to 11 years. The results for chondromalacia patellae were satisfactory to excellent results in 20 of 23 knees (87%) at two years and in eight of 15 knees (55%) at five to 11 years. Satisfactory to excellent results in 11 of 12 knees (92%) were noted for recurrent patellar dislocation. This procedure should be reserved for advanced chondromalacia patellae (Grades III and IV) and recurrent patellar dislocation. Anatomic studies suggest that the pain relief was most likely due to a combination of patellar denervation and restoration of patellar congruence.
A technique for avoiding the problem of patella baja following surgery for ruptured ligamentum patellae is described. Roentgenographic comparison of the operative knee with the normal knee can guide adjusting the tension on the wire loop commonly used for splinting.
Patella height was defined by the distance between the midpoint of the articular surface of the patella and the condylar plane, which was constructed perpendicular to the mechanical axis of the tibia. In two series of normal individuals the measured distances were related to body height and the length of the lower leg and thus expressed as its ratio, which was the same in both sexes. The measurements were performed on lateral radiographs of the knee and lower leg obtained in weight-bearing and 30 degrees to 40 degrees of knee flexion using a simple device to obtain a standardized position of the lower leg during the examination. The standing position is proposed for these measurements since the patellar ligament is shorter in the recumbent position. The method can be used for biomechanical analysis of the femoropatellar joint.
A 63-year-old man with bilateral congenital dislocation of the patella developed severe osteoarthritis of his knee joints. Bilateral total knee arthroplasty was performed without an attempt to correct the dislocated patella and extensor mechanism. Four years later the patient had excellent, painless function of his knee joints with stability and excellent quadriceps strength.
Two cases of previously unreported steroid-induced osteonecrosis of the patella were investigated. The first case was a 46-year-old man who had been receiving steroid therapy for three years for treatment of bronchial asthma. The second was a 32-year-old woman who had been receiving steroid therapy for nine years as treatment of systemic lupus erythematosus. Both reported slight knee pain. The roentgenographic findings revealed increased radiodensity with radiolucency of the upper one-half of the patella. A trephine biopsy revealed focal areas of dead trabecular bone.
Chondromalacia patellae is a relatively common condition affecting adolescents or young adults, involving the articular cartilage of the patella and opposing femoral condyles. Etiological factors, clinical features and radiographic signs of this condition are discussed. A conservative treatment approach is put forth emphasizing rehabilitative exercise, bracing and spinal manipulation.
Forty-one knees from adult cadavera (twenty female and twenty-one male) were dissected to study the relationship between the longitudinal axis of the patella and the angles of insertion into it of the vastus lateralis and vastus lateralis obliquus muscles. The mean and variance in the angles of insertion of the vastus lateralis obliquus tendon were found to be significantly different between men and women (p less than 0.05 and p less than 0.01, respectively). Three distinct anatomical patterns in the insertion of the vastus lateralis obliquus muscle were delineated. The vastus lateralis muscle, particularly the vastus lateralis obliquus, creates an important lateral force-vector on the patella.