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A 87-year-old woman with femoropatellar arthrosis sustained a fixed inferior traumatic locking of the patella with the knee in flexed position. After closed manipulation locking recurred and surgery was necessary to ensure smooth articulation.
Seventy-nine open patella fractures in 76 patients were treated between 1986 through 1994, with an 80% incidence of multiple injuries. All were treated with irrigation and debridement, open reduction, internal fixation, and reconstruction of the extensor mechanism. In no case was a primary patellectomy performed, even with severe comminution. There were three failures of initial fixation and one asymptomatic nonunion. Average range of motion for all groups was 112 degrees, at an average follow-up of 21 months. Secondary surgical procedures were performed in 65% of knees, the majority for symptomatic hardware. To determine long-term functional outcome, a modified Hospital for Special Surgery knee score was used. At an average of 36 months, good to excellent knee scores were observed in 17 of 22 patients. We conclude that all attempts for preservation of bone substance and precise reconstruction of the extensor should be attempted, reserving total patellectomy as a salvage procedure.
We report a new case of Ohdo syndrome with bilateral patella dislocations where surgical intervention has been indicated. A review of the skeletal manifestations reported in the literature on Ohdo syndrome reveals that joint laxity and skeletal deformities are important aspects of the phenotype.
Transverse stress fracture of the patella in a child is an exceptional injury in childhood. Only one case has been previously reported. The present study reports a new case of a 12-year-old boy with anterior knee pain misdiagnosed for 5 months as Sinding-Larsen-Johansson disease who developed sudden anterior right knee pain and pop while running in a soccer match. Surgery was performed. The evolution was favorable without any immobilization required and the patient achieved full recovery.
One-third of the adolescent patients followed up in our prosthetic clinic have developed patellar dislocation. Four cases are described, and radiographs are evaluated for femoral-tibial alignment, patellar height, and tibial length. Patella alta was present in each patient. We propose that the forces associated with the patellar tendon-bearing prosthesis may produce elongation of the patellar tendon in young patients and predispose them to patellar instability.
A 19-month-old nonambulatory child with knee flexion contractures was found to have dislocated patellae. Only three previous cases of bilateral congenital dislocated patellea have been reported. Surgical treatment rationale and technique are reviewed.
We report two patients with Turner's syndrome who presented with recurrent dislocation of the patella (RDP). Both had a positive family history of patellar instability. The association of RDP with Turner's syndrome has not been reported previously. A subsequent study in 14 patients with Turner's syndrome demonstrated radiographical patellofemoral incongruency in eight patients, but no clinical manifestation of patellar instability. Although the present study suggests a possible link between Turner's syndrome and patellofemoral incongruency, it could not ascertain whether or not Turner's syndrome predisposes a patient to RDP.
A patient is described who in addition to having the 48, XXXY Klinefelter syndrome has the autosomal dominant nail-patella syndrome, inherited through his mother from the grandfather. Clinical signs of both syndromes were found. Chromosomal investigation with BUDR incorporation and acridine orange staining showed that one X chromosome stained intensively, while the other X chromosomes were elongated and weakly stained. Difference in degree of stretching of the supernumerary chromosomes was noted. The occurrence of the two rare syndromes in the same patient is assumed to be fortuitous.
A 14-year-old boy is reported with bilateral hypoplastic patellae and multiple congenital skeletal anomalies. Since this constellation of bony malformations has not been described previously, we believe this represents a new syndrome most probably of genetic etiology.
A family in whom several members are affected with nail-patella dysplasia is reported because of severe renal involvement and bilateral antecubital pterygia. The family presented as arthrogryposis because of the elbow contractures.
The importance of "double tourniquet" technique in repair of the quadriceps mechanism after total patellectomy in recent fractures of the patella is described and its advantages are discussed. The results following this method of repair in 17 total patellectomies have been studied and discussed.
Ligamentum patella rupture following local steroid injection in an Australian Rules footballer is described. The relationship between local steroid injection and rupture of large ligaments and tendons is reviewed. Careful consideration prior to steroid injection is strongly suggested because of the risk of rupture of these structures.
Abnormally shaped, usually double-layered, patellae are recognized as occurring in multiple epiphyseal dysplasia. The case described is unusual in that an associated defect appeared in the femur and resulted in mechanical symptoms.
This report describes two cases of the Nail Patella Syndrome with renal involvement. Pathological studies include immunochemistry, light microscopy, immunofluorescence and electron microscopy. The possibility of secondary immune damage to altered glomerular basement membrane is suggested as a cause of the progressive renal disease which occurs in some of these cases.
A study on spastic knee flexion deformity has revealed a recurrence rate of 32 per cent following attempted surgical correction on 170 knees (103 patients). This rate appeared to be unrelated to concomitant surgery for correction of hip and ankle deformity. An additional study demonstrated patella alta in 72 per cent of 100 spastic knees (50 patients) and only 2 per cent and 50 knees of a comparable group of 25 non-spastic patients. It is suggested that restoration of a normal patello-femoral relationship may reduce both the functional disability and recurrence rate of spastic knee flexion deformity when this disease is managed surgically.
Nail Patella Syndrome (NPS; OMIM #161200) is a pleiotropic condition, with a classical clinical tetrad of involvement of the nails, knees, elbows and the presence of iliac horns. Kidney disease and glaucoma are now recognised as part of the syndrome. Fifty years ago, James Renwick chose NPS to develop methods of linkage analysis in humans and revealed the third linkage group identified in man--that between NPS and the ABO blood group loci. After a fallow period of some forty years, the gene mutated in NPS has been identified (LMX1B) and the condition serves as a model for understanding the complex relationships between disease loci, modifier genes and the resultant clinical phenotype.
Patellar tendinitis is a condition that occurs in patients who are involved in repetitive use of the extension mechanism. The most common symptoms are pain at the inferior pole of the patella, and radiographic changes may also occur. This case report demonstrates an extreme example of elongation of the inferior pole of the patellar tendon. The ossification caused the patient pain, which was resolved with surgical removal of the bone.
This study investigated the effect of strength training on the mechanical properties of the human patella tendon of older individuals. Subjects were assigned to training (n = 9; age 74.3 +/- 3.5 years, body mass 69.7 +/- 14.8 kg and height 163.4 +/- 9.1 cm, mean +/- S.D.) and control (n = 9; age 67.1 +/- 2 years, body mass 73.5 +/- 14.9 kg and height 168.3 +/- 11.5 cm) groups. Strength training (two series of 10 repetitions at 80 % of five-repetition maximum) was performed three times per week for 14 weeks using leg extension and leg press exercises. Measurements of tendon elongation during a ramp isometric knee extension were performed before and after training and control periods in vivo using ultrasonography. Training caused a decreased tendon elongation and strain at all levels of force and stress (P < 0.01). Baseline tendon elongation and strain at maximal tendon load were 4.7 +/- 1.1 mm and 9.9 +/- 2.2 %, respectively (maximum force: 3346 +/- 1168 N; maximum stress: 40 +/- 11 MPa). After training, these values decreased to 2.9 +/- 1.2 mm and 5.9 +/- 2.4 % (P < 0.01), respectively (maximum force: 3555 +/- 1257 N; maximum stress: 42 +/- 11 MPa). Tendon stiffness increased by 65 % (2187 +/- 713 to 3609 +/- 1220 N mm-1; P < 0.05) and Young's modulus increased by 69 % (1.3 +/- 0.3 to 2.2 +/- 0.8 GPa; P < 0.01). As a result of these changes, the rate of torque development increased by 27 % (482.8 +/- 302.5 to 612.6 +/- 401 N m s-1; P < 0.01) following training. No significant changes occurred in any measured variables in the control group (P > 0.05). This study shows for the first time that strength training in old age increases the stiffness and Young's modulus of human tendons. This may reduce the risk of tendon injury in old age and has implications for contractile force production and the rapid execution of motor tasks.