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At least 775 records · Page 43Linked to original sources
PubMed1977

Patellar-tendon transfer by the slot-block method for recurrent subluxation and dislocation of the patella.

In sixty-five knees followed for an average of 4.5 years after treatment of subluxation or dislocation of the patella by the slot-block method of medial patellar-tendon transfer, the results were satisfactory in fifty-four (83%) and unsatisfactory in eleven (17%). Recurrent subluxation or dislocation occurred in three (5%) of the knees and was attributed to insufficient displacement. Chondromalacia of the patella became worse after transfer in three of the sixty-two knees in which the distal realignment was technically correct. Two knees (3%) required patellectomy because of patellofemoral symptoms and there were nineteen complications in seventeen knees, including loss of motion in six, wound infection in six, displacement of the bone block in three, recurrent dislocation in three, and rupture of the patellar ligament in one. The method is believed to give superior results but it is technically demanding.

Humans↗
PubMed1997

Irreducible superior dislocation of the patella requiring open reduction.

The authors describe a case of superior dislocation of patella that was irreducible by closed methods. Extensive review of the literature revealed that this is the first case reported in which an open reduction was needed to reduce a superior dislocation of the patella to unlock the osteophytes, which were blocking the closed reduction.

Aged↗
PubMed1997

[Congenital dislocation of the patella in children and adolescents].

Eleven patients were treated at Orthopaedic Unit of Pediatric Surgery Department because of congenital dislocation of the patellae between 1988 and 1995. In 4 cases the condition was bilateral. Mean follow-up was 3 years and 7 months. Surgical procedures of Ali-Krogius-Roux-Goldwaith or Ali-Krogius-Hauser were performed. According to Hall and Michelli classification 6 results were rated excellent, 4 good, 3 fair and 2 poor. Flexion contracture of the knee resolved in all cases. Surgery employed proved efficient in treatment for congenital dislocation of the patella.

Adolescent↗
PubMed1976

Congenital dislocation of the patella.

In 8 congenital patellar dislocations, in 7 patients, the patella was permanently and laterally dislocated, and irreducible or difficult to reduce. The patella usually was hypoplastic and showed absent facets. The intercondylar groove of the femur also was underdeveloped. In all but one patient, knee function was improved by a surgical procudure which involved lateral release of ptella, medial transpositon of patellar tendon, and plication of medial capsule or advancement of vastus medialis.

Cartilage, Articular↗
PubMed1997

[Long-term results of condylar reconstruction using patella as vascularized graft].

PURPOSE OF THE STUDY: In 1966, R. Merle d'Aubigné published 4 cases of unicondylar destructions (due to trauma or tumor) reconstructed with the patella replacing the joint surface. Since this time the same technique has been used in 6 other cases. The results of these 10 patients are studied. MATERIAL AND METHOD: Six of the examined patients were treated initially for a giant cell tumor, 1 for a low-grade osteosarcoma, and 3 for post traumatic arthritis. The patellar transplant remains vascularized by it's supero-medial vascular bundle. The femoral condyle was affected in 9 cases, the tibial plateau in one. RESULTS: The long term follow-up of these 10 patients revealed unexpected satisfactory results. None of the operated knees was clinically "excellent", due to instability or axial deterioration, but function remained correct, with a good range of motion, active professional possibilities, and, often, regular practice of some sports, like skiing or tracking. Function was not correlated with radiological aspect. The arthritic remodeling of the knee was obvious in all of the cases, and regularly increasing. Five of the 10 knees had to be reoperated (one or several times): 3 during the first months of follow-up (1 for sepsis, 2 for supracondylar fractures), 5 during the first years, to improve function (2 arthrolysis, 2 valgus osteotomies, 1 loose bodies removal). Three patellar plasties had to be converted into a total knee prosthesis, after 8, 27 and 40 years. The follow-up of the 7 patients still walking on their patellar plasty is of 2, 4, 17, 19, 24, 24 and 25 years. DISCUSSION AND CONCLUSION: Condylar reconstruction using a vascularized patellar transplant is mechanically speaking an approximative, obsolete and rather rough procedure. Nowadays one would prefer a knee prosthesis, with or without auto or allografts, preserving the patella. The immediate functional result would certainly be better, but the future remains uncertain. The patellar plasty can delay for 10, 20 years or even more the time of a prosthesis. This technique might also be useful in countries where prosthetic implants are not easily available.

Arthroplasty, Replacement, Knee↗
PubMed1998

Ultrasound prenatal diagnosis of the Nail-Patella syndrome.

The Nail-Patella syndrome (NPS) is an autosomal dominant connective-tissue disorder characterized by the absence or hypoplasia of the nails and patella, posterior illiac horns, elbow deformities, congenital nephropathy cervical ribs and eye problems. The presence of the posterior iliac horns is pathognomonic and have been observed in more than 80 per cent of cases. In this report, we present the first case of prenatal diagnosis of NPS by ultrasound. The possible kidney involvement, combined with other, milder, complications make the prenatal diagnosis of this syndrome worthwhile.

Adult↗
PubMed1998

[Osseous reconstruction of the patella with screwed autologous graft in the course of repeat prosthesis of the knee].

PURPOSE OF THE STUDY: The aim of this study was to propose an original way of solving the infrequent but difficult problem of a thin patellar remnant. After removal of the loose patellar button of a knee prosthesis, several options are available: patellectomy should be avoided because of unpredictable results; patelloplasty may be the solution if bone quality is too poor and can allow for its improvement with time; recementing a new implant needs the remaining patella to be thick enough (more than 10 millimeters). MATERIAL AND METHODS: We advised reconstruction with an autologous monocortical iliac bone graft, harvested from the medial cortex of the anterior iliac wing, and shaped to accommodate for the patellar remnant. Its cancellous surface is opposed to the roughened patellar bone to which it is fixed by four 1.5 mm cortical screws (the heads of which are countersunk). Any defect will be filled with cancellous chips. The patellar button can then be cemented. Two cases with a long follow-up (5 years) are shown: one is a "typical" indication of isolated patellar loosening 16 years after implantation of a GSB total knee prosthesis, in a 91 year old woman. The other one illustrates the salvage of a "patellectomized" multi-operated knee, in which a trochlear implant was used as a first step, then 4 years later the patellar pseudarthrosed remnant was reconstructed. DISCUSSION: Indications of this technique are obviously rare: the patellar remnant should be thinner than 10 mm, in one piece (or easy to rebuild with the graft), the bone should allow a good purchase of the screws and the extensor apparatus should be in continuity. The first cases seem encouraging, as no secondary fracture or non-union has been seen at five years follow-up. The bone-cement lucency seems to be due to cementing on a cortical surface, but did not increased. Autologous bone has been favoured to increase the chances of union in a poor quality bed. It has the drawback of a second approach to harvest the bone at the iliac wing, where it is not always flat. The surgeon must "cheat" to get as flat a surface as possible for cementing. The loss of quadriceps is so troublesome that Buechel has proposed autologous grafting inside the patellar tendon and Bakay has used a mushroom-shaped allograft. Finally, we should like to advise against too much thinning of the patella to try and gain a few more degrees of flexion in total knee replacement: think of revision! CONCLUSION: We think this technique may be helpful in patellar loosening, as an other way of solving this problem.

Aged↗
PubMed1998

[A familial form of bilateral recurrent dislocation of the patella with major trochlea dysplasia].

PURPOSE OF THE STUDY: We report four cases of bilateral recurrent dislocation of the patella with major trochlear dysplasia, in the same family. MATERIAL AND METHODS: Details of clinical examination of all members of this family and measurements on knee radiographs are reported. RESULTS: In all cases a severe proximal dysplasia of the trochlea was described on lateral views. The patella and the trochlea had a normal shape on the axial view. DISCUSSION: In some recurrent dislocation, with no associated disease, possibility of a genetic transmission have been suggested in some publications. Cases involving the same family have never been reported to confirm a genetic transmission of a bilateral and major trochlear dysplasia. CONCLUSION: This report points out a genetic origin of severe trochlear dysplasia. To know more about transmission and chromosomic localisation, careful investigations on others families of bilateral dislocations with trochlear dysplasia must be done.

Adolescent↗
PubMed1996

[Early evaluation of surgical treatment for patella fractures].

From mars 1989 to mars 1992, 26 fractures of the patella were treated surgically in the "Orthopaedic and Traumatological center in Dakar". We have evaluated the functional and the anatomical results. The mean age of the patients was 45 years. The most common mechanism was direct trauma (24 cases). We have registered 12 opened fractures, 24 displaced fractures and 13 comminutive fractures. Surgical methods were modified tension band internal fixation (18 cases), tension band wiring for fixation (5 cases) and circumferential wire loop fixation (3 cases). The mean follow-up was ten months. Only eight patients have adequate post-operative kinesitherapy. So functional results was poor in 50% of cases. The anatomical reconstruction of the patella were achieved in 18 cases. We have observed a relation between: anatomical results and inadequate indications; excellent functional results and adequate kinesitherapy. So the authors recommend modified tension band internal fixation in transversal fractures and fracture with central communication. Tension band wiring for fixation is used in others comminutive fractures. Post operative kinesitherapy must be realized in a adequate center and criteria of functional evaluation be wider theses.

Adult↗
PubMed1998

Giant-cell tumor of the patella: report of two cases.

Two patients with giant-cell tumors of the patella are presented in this report. Both patients were young females who were noted to have had nonspecific anterior knee pain and mild swelling of 1 to 12 months' duration prior to admission to our hospital. Local tenderness over the peripatellar area and slight limitation of full flexion were noted during physical examination. The radiographic presentation of each patella appeared as an expansile and lytic lesion with a thin cortex, without evidence of intra-articular involvement. Chest radiography and routine laboratory examination results were normal. After biopsy, intralesional curettage with phenol cauterization and allograft reconstruction was the preferred treatment in these two patients, with both tumors considered to be stage 2 according to Enneking's staging system. Following surgery, range of motion exercise was started after 6 weeks of immobilization with a long leg splint. Both patients regained full range of motion and were pain free. Radiographically, bone remodeling without evidence of recurrence was noted in both patients 2 years postoperatively.

Adolescent↗
PubMed1976

[Chondropathy of the patella. Experiences with 100 medializations].

After a brief reference to the biomechanics of the patellofemoral joint, the anamnesis and the clinical and the radiologic symptomatology of chondropathia and the possibilities of its therapy are described. Patellofemoral arthrography is very helpful for the diagnosis. The technique of our operation is also described. After close study of current available literature and careful control of our 100 medialization cases, the results after 6, 12, 24, and 36 months are shown in tabular form. The operation is recommended for primary chondropathia patellae with lateroposition or lateral-tipped patella.

Adolescent↗
PubMed1996

Micromere formation at third cleavage is decisive for trochoblast specification in the embryogenesis of Patella vulgata.

Trochoblasts of the mollusc Patella vulgata differentiate early in development into ciliated cells due to a cell intrinsic developmental capacity. The third cleavage appears to be decisive for their specification. Permanent inhibition of cleavage after the third cleavage, as induced by a continuous incubation with the drug Cytochalasin B, had no effect on trochoblast-specific gene expression later in development. However, permanent inhibition of cleavage before third cleavage abolished trochoblast differentiation including trochoblast-specific gene expression. Inhibition of just the third cleavage itself was sufficient to repress trochoblast-specific gene expression. In contrast, inhibiting the second or fourth cleavage did not effect trochoblast-specific gene expression. Correct formation of micromeres at the third cleavage is required to obtain trochoblast-specific gene expression as was shown in experiments in which the formation of micromeres during third cleavage was suppressed by pressure. In addition, centrifugation before or during the third cleavage disturbs trochoblast-specific gene expression, whereas centrifugation after the third cleavage does not affect trochoblast-specific gene expression. Thus, during the third cleavage a decisive step in the determination of developmental fate of trochoblasts takes place, likely resulting in a segregation of activating and inhibitory determinants. Trochoblast-specific markers in Patella were only expressed in embryos that were division arrested after third cleavage. This suggests that a segregation of differentiation potentials has to take place before trochoblast differentiation markers are expressed. The restriction of differentiation potentials in the cleaving stage embryo is thus required to enable trochoblast-specific gene expression.

Animals↗
PubMed1985

Chondromalacia patellae. Results of operative treatment.

The series consisted of 26 patients operated on in 1972-1978 for chondromalacia patellae. The patients were followed up an average of 4.6 years after the operation. The operation involved one knee in 21 patients, both knees in 5. The primary operation was carried out for lesions of the articular cartilage of the patella alone in 18 cases (in 6 of these a second operation was necessary) and for a biomechanical disturbance of the patellofemoral joint in 13 cases. Degenerative changes of the patellar cartilage were observed at anatomo-pathological examination in 29 of 31 knees. On average, the patients' symptoms were alleviated after the operation, but comparison of different types of operation showed a statistically significant improvement only after operations that modified the biomechanics. The results confirm the view that symptoms originating in the patellofemoral joint often are due to biomechanical disturbances of this joint and the extensor system of the knee, and that the removal of injured cartilage alone is not sufficient.

Absenteeism↗
PubMed1996

Knee joint proprioception in patients with posttraumatic recurrent patella dislocation.

In 30 healthy volunteers with clinically inconspicuous knee joints and nine patients with posttraumatic recurrent patella dislocation, the proprioceptive abilities of the knee joint were evaluated by an angle reproduction test. The results of the control group showed no gender- or dominant-specific difference. The patient group showed a significant deterioration of proprioceptive capability in the injured knee joint. Even in the contralateral, uninjured knee joint, the angle reproduction test result was significantly reduced compared with the control group. After applying an elastic knee bandage, the control group and the patients with patella dislocation showed a significant improvement of the proprioceptive capability.

Adolescent↗
PubMed2006

Simultaneous patellar tendon avulsion fracture from both patella and tibial tuberosity: a case report.

We present a simultaneous patella tendon avulsion fracture from both sides of its attachment in an ectopic ossified patellar tendon. Medially two thirds of the patellar tendon was detached from the inferior patella, and laterally one third of that from anterior tibial tuberosity with the patellar tendon split. Osteosynthesis was used to restore the extensor mechanism of the knee. The result at 46 months was good, even though there were some remaining ectopic ossifications in the patellar tendon.

Aged↗
PubMed2002

Characterisation of two snail genes in the gastropod mollusc Patella vulgata. Implications for understanding the ancestral function of the snail-related genes in Bilateria.

Snail genes have been found to play a role in mesoderm formation in two of the three clades of bilaterians, deuterostomes (comprising the chordates) and ecdysozoans (comprising the arthropods). No clear data are available on the role these genes play in development of the mesoderm in the third clade, that of lophotrochozoans (comprising annelids and molluscs). We identified two new members of the snail gene family in the gastropod mollusc Patella vulgata. Phylogenetic analysis showed that the two genes clearly belong to the snail sub-family. Their expression patterns do not indicate a role during early mesoderm formation. In fact, contrary to expectations, the snail genes of Patella were mostly expressed in the ectoderm. In view of the location of their expression sites, we suggest that these genes could be involved in regulating epithelial-mesenchymal transitions (EMT) and cell motility, as has recently been demonstrated for snail genes in vertebrates. This may well correspond to the ancestral function of these genes. The results are discussed in the light of the evolutionary origin of the mesoderm. Electronic supplementary material to this paper can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00427-002-0228-1.

Amino Acid Sequence↗
PubMed1998

Cyclin A, cyclin B and stringlike are regulated separately in cell cycle arrested trochoblasts of Patella vulgata embryos.

Trochoblasts are the first cells to differentiate during the development of spiralian embryos. Differentiation is accompanied by a cell division arrest. In embryos of the limpet Patella vulgata, the participation of cell cycle-regulating factors in trochoblast arrest was analysed as a first step to unravel its cause. We determined the cell cycle phase in which the trochoblasts are arrested by analysing the subcellular locations of mitotic cyclins. The results show that the trochoblasts are most likely arrested in the G2 phase. This was supported by measurement of the DNA content in trochoblast nuclei after the last division. Trochoblasts complete their final division at the sixth mitotic cycle. This mitotic cycle resembles the first postblastoderm cell cycle of Drosophila, in which mitotic activity is controlled by expression of the string gene. As failure of string expression results in cell cycle arrest in the G2 phase, negative regulation of a Patella string homolog could be responsible for trochoblast arrest. Although Stl messengers disappeared from trochoblasts during their final division, expression was observed again 20 min later. Messengers remained present in all trochoblasts at low levels during further development. Thus, expression of the stringlike gene allows the cell cycle arrest of these cells, whereas in Drosophila cells arrested in division lack string messengers.

Animals↗
PubMed1999

Development of the musculature in the limpet Patella (Mollusca, Patellogastropoda).

Whole-mount technique using fluorescent-labelled phalloidin for actin staining and confocal laser scanning microscopy as well as semi-thin serial sectioning, scanning and transmission electron microscopy were applied to investigate the ontogeny of the various muscular systems during larval development in the limpets Patella vulgata L. and P. caerulea L. In contrast to earlier studies, which described a single or two larval shell muscles, the pretorsional trochophore-like larva shows no less than four different muscle systems, namely the asymmetrical main head/foot larval retractor muscle, an accessory larval retractor with distinct insertion area, a circular prototroch/velar system, and a plexus-like pedal muscle system. In both Patella species only posttorsional larvae are able to retract into the shell and to close the aperture by means of the operculum. Shortly after torsion the two adult shell muscles originate independently in lateral positions, starting with two fine muscle fibres which insert at the operculum and laterally at the shell. During late larval development the main larval retractor and the accessory larval retractor become reduced and the velar muscle system is shed. In contrast, the paired adult shell muscles and the pedal muscle plexus increase in volume, and a new mantle musculature, the tentacular muscle system, and the buccal musculature arise. Because the adult shell muscles are entirely independent from the various larval muscular systems, several current hypotheses on the ontogeny and phylogeny of the early gastropod muscle system have to be reconsidered.

Animals↗