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The authors have treated two cases of severe genu-recurvatum after poliomyelitis by a locking operation. They fused the patella to the tibia by grafting, realising an anterior shelf-operation. Full flexion was preserved, hyper-extension was decreased. The indications of this operation are discussed and compared with these of tibial osteotomies and capsulorraphies.
Giant-cell tumors are an infrequent clinical, radiological, and pathological entity observed in 5% of primary bone tumors. They generally occur at the epiphysis of long bones, particularly in the knee area but patellar localization seems very rare. Despite their perfectly benign histological aspect, giant-cell tumors may be aggressive, leading to local recurrence or even distant metastasis to the lung. We report a case of benign giant-cell tumor of the patella with lung metastasis observed in a 23-year-old woman. The aggressive radiological image was suggestive of chondrosarcoma. Histologically the differential diagnosis with chondroblastoma was difficult. The tumor and lung metastasis were treated by surgical resection. Four years later there has been no recurrence. We present the anatomic and clinical aspects of giant-cell tumor of the bone together with the diagnostic approach and the clinical course.
This is a report of 6 cases (one bilateral) of congenital irreducible, permanent lateral dislocation of the patella, ages 5 to 14; 2 patients were normal and 4 were mongoloid. The dislocation was reduced by means of a newly-devised surgical reconstruction of anterior attachments of nearly all of the para-articular bone and ligamentous structures. The 2-year follow-up results are satisfactory.
A case is reported of a solitary metastasis of the patella from a "poorly differentiated adenocarcinoma", the first sign of the primitive tumour for a long time unidentified. The authors point out that this occurrence, although rare, should be considered in the differential diagnosis of knee pain.
Anatomical condition and congruence of the patello-femoral joint after differently treated fracture of the patella was assessed on the basis of roentgenometric analysis of radiographs of 39 patients. The best situation was found in surgically treated cases with the use of the wire loop (cerclage), less favorable in patients managed conservatively and the worst in patients operated after Weber.
The late results of partial patellectomy in treatment of fracture of the apex or the 1/3 of the peripheral patella have been presented. Fourteen patients were evaluated. Attention was paid to the dependence of the result on the correct surgical technique. Full painless range of movements in the operated on knee was achieved in 7 persons. In the other 7 patients, extension of the knee was full but flexion was moderately limited. Periodical pain occurs in 3 persons.
Controversy persists as to whether the patella should be resurfaced in total knee arthroplasty. Can the good results of patellar cartilage against the metal femoral component be expected to endure? Attention to technique can be expected to reduce some of the complications of resurfacing, notably fracture, rupture, and instability. Component breakage results from metal-backed designs, and the causes of patellar clunks have not been fully understood.
Subchondral bone density (by means of CT osteoabsorptiometry), and cartilage thickness (directly measured on photocopies of frozen sections), were examined in 30 human patellae, with an age range from 47 to 90 y. A surface demonstration of the distribution was prepared, and representative pictures produced by summation with a computer. Subchondral bone-density maxima were found in the proximal part of the lateral facet, and the density pattern interpreted as the expression of the long-term distribution of stress in the joint. It is reasonable to assume that cartilage thickness, of which two-thirds of the maximum values occupy a lateral position, is also dependent on the local stress. The 2 distributions show correlation coefficients > 0.5 in approximately a third of the cases we examined. Displacement of the higher values of cartilage thickness relative to the subchondral density maxima is attributed to incongruence in the medial part of the joint.
Dorsal defect of the patella (DDP) is an uncommon but well-documented disease entity. We report a case of bilateral DDP with patellar hypoplasia and patello-femoral malalignment. Detailed imaging features including radiographic, magnetic resonance imaging, and computed arthrotomographic appearances, are described.
Nail-patella syndrome is a rare disorder, which is inherited as an autosomal dominant trait. This condition is also known as hereditary osteo-onychodysplasia or Fong's syndrome. Posterior iliac horns are commonly found in this syndrome and are considered pathognomonic. In this report, we describe the appearance, location, and structure of iliac horns with respect to radiography and magnetic resonance imaging.
In this study 17 patients with recurrent dislocation of the patella were followed up 10 years after Goldthwait-operation. The subjective and clinical findings were excellent rsp. good in 70%, whereas the x-ray findings showed osteoarthritis of the femoropatellar joint in 60%. Concerning the aetiopathological factors we found an increased external torsion of the afflicted extremity measured by computed tomography.
The suture of tissues resected during surgical tendomyolysis and arthrolysis of the knee joint required by its extension contracture is carried out during tibial flexion at an angle of 90 degrees. This can lead to the development of a diastasis of the tendinous distortion of the patella and of the joint capsule which prevents the suture of the wound. It is suggested to repair the resulting tissue defect with the use of a split flap of local tissues with a wide base situated in front of the defect. The flap is dissected from the lateral part of the tendinous distortion and of the capsule. The flap is turned by 180 degrees around its base and extended to cover the defect with its subsequent suture to the opposite edge of the defect. The described supplementary surgical procedure is technically uncomplicated and results in stable anterior and lateral joint structures, in a reduction of the risk of complications due to infection, and allows an early initiation of active kinesitherapy in the early postoperative period.
MR imaging with a 0.02 T resistive magnet was used to establish the correlation between the histologic grading of patellar cartilage degeneration and fat water separation images or T1- and T2-relaxation times. We examined 23 cadaveric patellae. There was a positive correlation between histologically graded cartilage degeneration and T1-relaxation time. Patellar cartilage was well differentiated from surrounding structures on chemical shift water proton images, and an evaluation of cartilage degeneration was possible. No correlation was found between cartilage damage and T2-relaxation time. Chemical shift imaging at 0.02 T is easy to perform and gives further information of cartilage disorders.
Recently, ultrasound transmission velocity (UTV) has been used to assess skeletal status. The basic principle of UTV measurement of bone is that the speed at which ultrasounds propagate in bone is determined by the mass density and by the index of elasticity, which is intimately correlated with bone strength. Theoretically UTV should provide more information about bone fragility than the absorptiometric techniques of measurement of bone mass. To test this hypothesis, UTV was measured using the SIGNET(TM) (Osteo Technology, Framingham, MA, USA) in the patella of 79 postmenopausal nonobese women. The subjects were divided into 2 groups: 29 postmenopausal normal women (NPM) and 50 patients with at least one vertebral crush fracture due to postmenopausal osteoporosis (PMO). Besides UTV measurements in all subjects lumbar spine bone mineral density (BMD) was measured by dual energy Rx (Hologic QDR 1000). UTV in NPM (mean age 57.9 +/- 8 SD years) averaged 1867 +/- 62 m/sec, and in PMO (mean age 63.5 +/- 7.8 SD years) averaged 1771 +/- 74 m/sec. It follows that the difference between the two groups was about 96 m/sec. UTV correlated significantly with BMD measured in the lumbar spine (r = 0.51; p less than 0.001), giving a discrimination power virtually identical to that obtained by using spine BMD values. This preliminary data are promising for the use of this new technique which offers a simple, noninvasive measure of bone quality without the limitation of radiation exposure.
Osteochondritis dissecans of the patella is a rare cause of anterior knee pain. An illustrative case in a 22-year-old man demonstrates the current imaging modalities and surgical treatment. Specifically, magnetic resonance imaging (MRI) and arthroscopic knee surgery are discussed along with a review of the literature. Unlike standard roentgenograms, MRI can be helpful in determining the viability of the osteochondritic fragment and the amount of remaining attachment to the surrounding cancellous bone. This finding can have important bearing on choice of treatment. When surgery is indicated, arthroscopic treatment with excision of the fragment and curettage offers distinct advantages over open arthrotomy. Lateral release or other realignment procedures may be done in combination with the primary procedure. Prognosis for full recovery of knee function and relief of patellar pain is guarded in patients who require surgery.
Nontraumatic, hematogenous osteomyelitis of an unfused patella occurred in a 62-year-old female patient, 50 years after septic arthritis of the knee was treated in childhood by femorotibial fusion. This extremely rare condition was successfully treated by a patellectomy, continuous irrigation, and antibiotics. This occurrence seems not to have been reported previously in English literature.
The early diagnosis of osteomyelitis of the patella in children can be difficult due to the rarity of this infection and to the vagaries of presentation which may be either acute with systemic signs or insidious with mild local signs. We present four cases of patellar osteomyelitis to illustrate the spectrum of this disorder. There should be a high index of suspicion with persistent pain and swelling above the knee, septic prepatellar bursitis, and septic knees that do not respond to conventional management. Management parallels treatment of osteomyelitis of other bones.
Patellofemoral osteoarthritis is a common disease which may occur alone or in association with tibiofemoral gonarthrosis. In cases of isolated symptomatic patello-femoral osteoarthritis with typical lateral malalignment and formation of osteophytes at the lateral border of the patello-femoral joint we perform a lateral facetectomy of the patella and associated lateral retinaculum release. The results of a prospective study of 20 cases with a mean follow-up of 2 years are presented. A good-to-moderate result was obtained in 90%. The average age was 60 years. We had 2 failures with a subjective rating of poor. The principal reason was tibiofemoral gonarthrosis too far advanced at the time of the operation, which then progressed in the postoperative course. On the other hand this technique results in marked improvement for many cases and carries only a small risk. Further reconstructive surgery of the knee is not excluded. Because of the minor surgery and quick recovery, this operation presents a valid alternative to more involved operations such as patellectomy, Bandi or Maquet reconstructive procedures, or a patellofemoral prosthesis.