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Nail-patella syndrome is a rare hereditary disease. We report a patient who was the lone member affected in the family. The patient additionally had a bony defect of the skull which has not been reported so far in the literature.
The treatment of chondromalacia of the patella is a medical problem. There are no sure concepts of therapy. We have analysed the value of the only lateral release or shaving by motorizised instruments or the combination of both methods. After lateral release have many patients no pain but the other methods also helped many patients. The comparison of these groups is impossible because of the different structure. A prospective randomised study has to bring the answer to this question.
We evaluated the results of excision of the fragment in 16 patients with symptomatic bipartite patellae. In nine, the pain began following trauma; in seven, the onset was insidious. The pain was aggravated by activity in all patients. The average age at surgery was 14 years, 6 months, and the average postoperative follow-up was 7 years. Fifteen of the patients were markedly improved; one was not.
Osteochondritis dissecans of the patella, a rare condition producing knee pain in the athlete, is considered to be the result of repeated shear forces producing microtrauma. We present the case of a fencer who developed this injury. The confirmation of the diagnosis by magnetic resonance imaging scan is demonstrated, and the literature is reviewed with an emphasis on treatment. The physician treating athletes with anterior knee pain must consider this entity in making the differential diagnosis.
Traumatic dislocation of the patella is an infrequent occurrence favored by dysplasia of the extensor apparatus of the knee. The problem of diagnosis is at the basis of a choice of treatment, as any pre-existing dysplasia may be worsened by traumatic dislocation. Furthermore, the presence of a patellar or femoral osteochondral fragment, a more frequent finding than is generally believed as demonstrated by arthroscopy, influences surgical treatment. The results of 37 cases are reported, and several details related to surgical method discussed.
When accurate reduction and stable fixation cannot be achieved in comminuted patellar fractures, degenerative changes in the patellofemoral joint can cause troublesome complaints. Our results show that partial or total patellectomy can produce a very good percentage of satisfactory results. In spite of several biomechanical studies that demonstrated the reduced efficiency of the quadriceps mechanism after partial and total excision of the patella, most patients achieved good or excellent results after a long follow-up period. All patients showed decreased isokinetic performance of the quadriceps muscle. There was no clear correlation between the clinical score and the data on isokinetic performance. Patellofemoral or femorotibial osteoarthritis and calcifications in the patellar ligament did not lead to an unsatisfactory clinical result.
Sinding-Larsen-Johansson disease and sleeve fractures are two injuries that occur at the inferior pole of the patella in children. The first is a chronic tendinitis accompanied by calcification of the avulsed patellar tendon. The latter are acute injuries that involve a complete avulsion of the proximal insertion of the patellar tendon with a small fleck of bone and portion of patellar articular cartilage. Illustrative case histories and a literature review are presented.
The cartilage model of the rat's patella constitutes a formation susceptible of inducing ossification, following its transplantation in a variety of sites (muscle, thyroïd, testis, ovary, anterior chamber of the eye, etc.), including those considered inappropriate in other experiments of induced ossification (liver, kidney). So we have an experimental model allowing the influence on the osteogenesis of various factors, local or general, natural or experimental, to be studied. Ossification occurs in this model only in cases of histocompatibility between donor and recipient. It is constant after autotransplantation or isotransplantation. It is never seen after heterotransplantation. In cases of homotransplantation its frequency varies: this is not influenced by the technical conditions of implantation but by tissue compatibility and the age of the animals giving and receiving. A private perichondrium cartilage retains its osteogenic potency. A cartilage killed by alcohol or cold no longer demonstrates its osteoformative capacities, even when put into contact with a living cartilage. Our findings are difficult to reconcile with the hypotheses invoking the osteogenic potency of the periosteum, or the intervention of substances either inducing osteoformation or inhibiting vascular invasion, for the explanation of endochondral ossification. However, they lead one to the opinion that chondrocytes play an active role in its release.
It is not easy to perform clinical diagnosis of chondromalacia patellae. Many cases take a clinically silent course and are discovered by chance only. Analysis for 275 arthroscopies resulted in almost complete agreement between clinical and arthroscopic diagnosis if the damage to the cartilage was diagnosed before arthroscopy. On the other hand, in chondromalacia that remained clinically silent, damage to the cartilage was present in 67% of the cases as detected by arthroscopy. The authors offer detailed comments on the problem of localisation of cartilaginous changes.
Follow-up examination were carried out on 43 patients with habitual or recurrent dislocation of the patella. The operation had been performed according to Ali Krogius. The subjective and objective results were summarized and the indication given hitherto was examined and corrected.
Four different methods of internal fixation of transverse fractures of the patella were experimentally evaluated in eight cadaver knees: circumferential wiring, tension band cerclage, cerclage over Kirschner wires and the Lotke's method. Linear and angular displacements were accurately measured by means of a micrometer while actively extending the knee from 90 degrees of flexion to full extension. Circumferential wiring gave the highest displacements, up to 25 mm at 30 degrees of flexion on average. Tension band cerclage showed much better results but the greatest stability was obtained with the cerclage over Kirschner wires and with the Lotke's technique which yielded displacements of less than 1 mm. These last two methods combine the tension band principle and transosseous fixation, which are both essential to obtain a stable fixation.
Three cases of acute haemotagenous osteomyelitis of the patella in children less than or equal to 9 years of age were reviewed. The purpose of this paper is to report these cases because of the extreme rarity of the location and the direct relationship of blood supply to this sesamoid bone with the involved areas. The treatment followed was surgical and the clinical and radiological results appear to be excellent after 4.8 and 12 years respectively.
A case of a fully developed hereditary onycho-osteo-arthrodysplasia (nail-patella syndrome) is presented. The typical signs, such as the iliac horns or variations of the knees, cubitals and nails should be familiar to every radiologist. The associated nephropathy seems to be caused by typical changes in the glomerular basement membrane seen in electron microscopy. Asymptomatic proteinuria is found in about 60% of the cases, in 5.5-8% the disease leads to the necessity of haemodialysis because of renal insufficiency. Hence, early diagnosis is very important.
In consideration of the multiple anatomical structures involved in recurrent subluxation of the patella and in external patellar hypertension syndrome, the authors propose an operation which allows for complete realignment of the extensor apparatus by transposition of the anterior tibial tuberosity, division of the external alar ligament, tightening of the internal alar ligament, and correction of the muscular insertions. In particular, removal of a capsulofascial band medially and its reimplantation into the external incision is proposed, thus avoiding the formation of retractive scar tissue. The long-term results, which were overall satisfactory, confirm the effectiveness of the operation proposed.
Forty-seven patients with a chronic anterior cruciate ligament (ACL) deficiency were treated with patella tendon ACL reconstructions from July 1980 to September 1983. All patients had a minimum two-year follow-up period (range, 24-54 months). Forty-two patients (89%) had meniscal damage in association with the ACL deficiency. This included seven menisci (17%) that had a stable tear and were left in place without suture fixation. Only five patients (11%) had normal menisci at the time of reconstruction. Functional and subjective results were obtained from a questionnaire that included a comprehensive evaluation of patients' symptoms and activities. Objective results were analyzed on the basis of a thorough physical examination, augmented with arthrometer instrumented drawer testing. The detailed questionnaire was returned by 42 patients (89%). Follow-up examinations were obtained for 37 patients (79%), with arthrometer testing of 35 patients (75%). A 100-point rating scale defined objective, subjective, and functional results. Stability testing, using Lachman's test, was judged to be less than or equal to 5 mm of anteroposterior tibiofemoral translation in 51% of the patients examined and less than or equal to 10 mm of translation in 89%. Stability by arthrometer testing was less than or equal to 5 mm side-to-side difference in 83%. No patient lost a menisci after reconstruction. This included six patients with stable tears that were left unsutured. Subjective results were good or better in 60%. Functional results were good or better in 52%, with 41 of 42 patients participating in some form of recreational sports postoperatively. There was a large discrepancy between objective findings and the subjective and functional results (14% poor results compared with 31% and 43%, respectively). Although objective stability could be surgically restored in an ACL-deficient knee, the quality of the knee at the time of reconstruction as well as the postoperative and rehabilitative regimen are implicated in patients with poor subjective and functional results.
The radiological and clinical features of two families with a nail-patella syndrome are described. Our findings emphasize the varying expressivity of the syndrome, which has an autosomal dominant mode of inheritance and a penetrance of 100%. It is important for the radiologist to be aware of the syndrome's stigmata so that renal failure can be detected as early as possible after the diagnosis of skeletal dysplasia.
A two-year-old child with the clinical stigmata of nail-patella syndrome, congenital urinary tract anomalies and proteinuria underwent renal biopsy. Electron microscopy revealed characteristic electron lucent areas and collagen fibril-like deposits in the glomerular basement membrane. Of special interest, electron dense deposits were seen in subendothelial areas of the capillary loops and immunofluorescent staining was striking, particularly for IgM, in a peripheral capillary loop pattern.
Patellar fracture after knee arthroplasty was found in 11 patients (12 knees) during a 15-year period. Causes of this fracture include trauma, technical factors, and biophysical factors. The incidence of this infrequent complication was significantly increased after patella resurfacing and revision arthroplasty. Minimally displaced, non-comminuted fractures were immobilized, whereas displaced, comminuted fractures with loose patellar prostheses were treated operatively. At a mean follow-up period of 28 months, the average knee score was 75 points. The average arc of motion was 87 degrees, and six of the 11 patients have returned to their prefracture functional level. Treatment should be individualized on the basis of fracture displacement, comminution, and button fixation.