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The occurrence of patella cubiti in dogs and man and its clinical signs, diagnosis, and treatment are described. The origin of the bone is discussed and it is concluded that the bone might be part of the normal anatomy. At present the prevalence of the bone in dogs is under investigation at Cornell University.
Three cases with collagenation of glomerular basement membrane are presented. The ages of the patients are 8, 13, and 27 years. An 8-year-old boy presented with nephrotic syndrome; a 13-year-old girl presented with recurrent urinary tract infections, proteinuria, and edema; and a 27-year-old woman was noted during the evaluation of a cardiac murmur to have proteinuria and renal insufficiency. The changes on electron microscopy were identical to those observed in nail-patella syndrome, a rare hereditary disease with ectodermal and mesodermal involvement, manifested as bony and nail abnormalities. Nephropathy is now a well established part of this syndrome. Our cases did not have the typical bony and nail changes. We feel these three cases represent a partial gene penetrance or manifestation of only a portion of gene complex involved in this syndrome.
A case of nail-patella syndrome is presented in which cerebral vessel and aortic dilatation was noted. The skin revealed epidermal basement membrane thickening and redundancy in addition to significant perivascular basal lamina reduplication by electron microscopy. The significance of these findings is discussed.
Seventy-one patients with 81 operations for correction of patellar instability are reviewed. Follow-up was for at least five years. The various preoperative symptoms, signs, and radiographic findings are presented. Two types of patellar instability become clear. One type is usually bilateral and secondary to general ligamentous laxity. A second type, usually unilateral with distinct physical findings, is secondary to trauma. The operative technique and results of surgery and physical therapy are discussed. A new rational approach to the operative treatment of recurrent subluxation and dislocation of the patella is proposed. The operative procedure would depend on the Q angle. For a Q angle of less than 14 degrees, a proximal realignment is sufficient. For a Q angle greater than 14 degrees, a distal realignment would be necessary in addition.
The incorrect position of the anterior tibial tuberosity responsible for the pushing into jagged shape of the extensor apparatus of the knee has various causes. Among these, "knock-kneed"walking may induce some children to compensate by a hyper rotation of the legs in order to reestablish a normal walking position. Other origins may also be pointed out : --an outward twist of the leg bones --hyper rotation in outward turning sometimes as a result of accident but more often hereditary. The closing of angle Q of the extensor system modifies the pressure vectors on the femur patellar connection leading eventually to disturbances in the growth of its outer side and to a distension of the inner stabilizing elements leading to partial dislocation of the patella. This physiopathological conception should lead to a selective therapeutic orientation based on a clinical examination. In this field much can be said for dynamic interventions (lowering of the vastus medialis transferring of the pes cornivus muscles, etc...) aimed at correcting the imbalance.
One hundred patients with osteoarthritic knees were randomized either to have their patella resurfaced or not resurfaced using the same total knee replacement. These patients were assessed preoperatively and a minimum 2 years postoperatively using disease-specific (Knee Society Clinical Rating System) and functional capacity (30 second stair climbing and knee flexor and extensor torques) outcome measures. Two patients in the not resurfaced group required reoperation because of anterior knee pain. At 2 years' followup, the not resurfaced group had significantly less pain and better knee flexor torques than did the resurfaced group, whereas the results of the Knee Society Function Scores, 30 second stair climbing, and knee extensor torques were similar. These results suggest that longer-term followup is required, but that one should keep an open mind regarding patellar resurfacing during total knee replacement.
The authors report six cases of detachment of the accessory fragment in "patella partita". This lesion is often unrecognised, especially among athletes. It gives rise to painful symptoms that are at first severe and later less marked. These symptoms disappear completely in both acute and chronic cases with the removal of the detached accessory fragment.
PURPOSE OF THE STUDY: Progressive dissolution of the supero-lateral fragment of a bipartite patella is reported. MATERIAL AND METHODS: The patient, a 44 year old professor of gymnastics, was examined for long standing anterior knee pain. For many years, his daily activities included forceful knee flexion exercises. Serial radiographs, between 1986 and 1990, revealed a progressive fragmentation of the accessory ossification center and accompanying calcific deposits in the lateral patellar retinaculum. RESULTS: Surgical excision of the calcific mass and accessory ossification center relieved the painful symptomatology completely, allowing the patient full normal function at one year's follow-up. DISCUSSION: The pathological findings were compatible with a dystrophic calcinosis associated with detritic synovitis. A pathogenic mechanism is hypothesized for this unusual and progressive course of a common condition: Repetitive trauma, in this case forceful knee flexion exercises, shear microscopic bony fragments of the poorly vascularized accessory ossification center. These microscopic fragments act as deposits of an apatite crystal which go on to induce the secondary soft tissue calcifications seen in our patient.
Tuberculosis in an isolated localization in the patella is rarely reported. Five cases were found in the literature. Two new cases together with the radiographic work-up to be performed in case of a "painful" knee are presented. Histology of the curetage specimen is required to reach certain diagnosis and develop an adapted management strategy to protect the functional future of the knee.
The case of an 81-year-old woman with persistent post-traumatic pain of the knee linked to tophaceous gout of the patella is presented. This gout was associated with adenomatous primary hyperparathyroidism. The relationship between hyperuricemia, hyperparathyroidism and chronic renal failure is discussed.
We report a case of chondroblastoma of the patella, associated with an aneurysmal bone cyst and pathologic fracture, that presented as knee pain in a 13-year-old girl. This case is the fifth case in the literature that associates patellar chondroblastoma with fracture, which should probably be regarded as a significant feature of this lesion.
A new technique using a minifragmentation plate to assist in the open reduction and internal fixation of displaced, comminuted distal-pole patella fractures was used in three patients with good results. This technique adds to the choices of treatment available to the orthopaedic surgeon who manages these difficult fractures.
Sixty-seven patients (69 knees) with recurrent patellar dislocation underwent either a lateral release (20 knees), a proximal realignment (14 knees), a distal realignment (16 knees), or a combined realignment (19 knees) procedure. Average respective followup was 8, 8, 6, and 4 years. Patients undergoing lateral release experienced a 40% recurrence of patellar dislocation. After a realignment procedure, redislocation was uncommon (4%), but pain and swelling were reported by 12% of the patients. Significant patellofemoral crepitation was present in 35% of the realignments. The congruence angle was corrected satisfactorily in the proximal realignments, but it remained abnormal in 25% of the distal realignments. The distance from the tuberosity to the sulcus was restored to normal by transposition of the tibial tuberosity, but remained abnormal in 36% of the proximal realignments. However, it did not preclude a good clinical result. Lateral release cannot be recommended for knees with severe dysplasia of the extensor mechanism. Proximal, distal, and combined realignments yielded similar clinical results. Retensioning of the medial structures and lateral release are effective in reducing the patella within the sulcus. Although transposition of the tuberosity is appealing, clinical advantages are less evident.
This is a report of three children with tender painful patellae, bipartite at the superior, lateral pole. Non-operative treatment failed to relieve these symptoms, but excision of the accessory ossification center resulted in a painless knee. Gross and microscopic pathological examination was consistent with the hypothesis that this syndrome was caused by fracture through the interposed cartilage which failed to heal satisfactorily.
Although gout is known to cause destruction of bone by the deposition of tophaceous material, the documented cases of pathologic fractures due to gout are rare. We report the case of a pathologic fracture of the patella. Union of the fracture was seen at 3 months after surgery.
A 54 years old female with significant impairment of renal function is presented. On physical examination, the presence of dystrophic nails, elbow dysplasia and prominent iliac horns. Familial study showed similar nail and bone deformities in 3 of six sons. The nail patella syndrome diagnosis was based on these findings. This is a rare autosomal dominant hereditary disease, probably related to congenital alterations in collagen metabolism. Clinical characteristics include bone abnormalities that principally involve knees and elbows, nail alterations and the presence of iliac horns, that are considered pathognomonic of the syndrome. Renal involvement is observed in 30 to 55% of cases. This patient had also an IgA-lambda paraprotein, whose relationship to the above mentioned syndrome is uncertain, since no evidences of malignant plasma cell dyscrasia were demonstrated.
Two patients with Rubinstein Taybi Syndrome (RTS) were found to have congenital dislocation of the patella (CDP). The dislocation was bilateral in one patient. Both underwent surgical reduction and stabilisation. The dislocation recurred in one patient who had associated genu valgum and external tibial torsion at the time of stabilisation. We feel that early diagnosis of CDP in patients with RTS is important to help early mobilisation and avoid secondary degenerative knee changes occurring.
Stress fracture of the patella in a twenty-nine-year-old palmwine tapper is reported. The fracture occurred during a busy tapping day which was his first working day after a ten-day sick off for a febrile illness and presentation was delayed for six weeks. Initial diagnosis was pathological fracture, but X-ray examination and histology of the biopsy from the fracture site did not suggest any associated disease. The pathomechanics of palmwine tapping is very similar to jumping (parachute) which is the usual cause of this fracture in developed countries.