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The authors report on an observation of acute osteomyelitis of the patella in a non-sickle-anemic 8-year-old child. The literature helps confirm the scarcity of the disease, the difficulties of diagnosis and the good prognosis of the lesion in the child.
We describe the case of a 56-year-old woman who, despite having bilateral habitual dislocation of the patella, remained asymptomatic until an injury to her left knee. We suggest that there is a need for a randomized study to evaluate the results of surgical and nonsurgical treatment.
We report the case of a six-year-old boy with Down syndrome who presented with flexion contractures of both knees and genu valgum. The diagnosis of bilateral congenital dislocation of the patella was established by clinical and xray examination. The patient was treated surgically with a satisfactory result.
Aneurysmal bone cysts are uncommon lesions accounting for less than 1% of reported primary bone tumors. This case study reports the ninth primary aneurysmal bone cyst of the patella, and the second to be reported in a white male patient. The scarcity of reports in this vulnerable site may refute trauma as the cause. If the articular surface is spared, this lesion can be treated successfully by curettage and bone grafting, once a definitive diagnosis is made.
The knee is a common site for injuries of the cartilage, capsule and ligament, which calls for the use of noninvasive techniques to assess injury severity properly and to plan adequate rehabilitation. Our study was aimed at comparing MR with isokinetic findings. To this purpose, 40 patients were examined; they were all affected with chondromalacia patellae, grades I-III, previously diagnosed at arthroscopy. Namely, 8 patients had grade I and 32 grades II and III chondromalacia. After MR and isokinetic exams, all patients were submitted to a standardized rehabilitation program. Our results indicate a marked decrease in quadriceps strength, especially in the most severe cases; in less severe cases, recovery was complete at 6 months, while the deficit remained in grades II and III injuries. MR yield was not relevant in 4 of 8 cases, while isokinetic findings were negative in one case. Both methods were positive in the most severe cases. At 6 months, both functional and MR findings were normal in grade I injuries, while some alterations remained in the others.
Onycho-osteodysplasia is an unusual disorder that affects bone, fingernails, and the kidneys. The knees may be involved with a hypoplastic, dislocated patella, and premature osteoarthritis with deformity may develop. The following is a case report of a patient with this disorder in which a total knee arthroplasty was performed.
Patellar fractures usually occur from distraction and three-point bending of the patella as well as from direct blows. Surgical treatment is necessary for fractures that are displaced more than 2 mm and may include open reduction and internal fixation, partial patellectomy, or rarely, total patellectomy. We have presented a new technique for the stabilization of a simple transverse fracture that has provided superior results in laboratory tests. Postoperative complications can be minimized by good attention to wound care, accurate fracture reduction, secure fracture fixation and an early range of motion. Despite the surgeon's best efforts, however, post-traumatic osteoarthrosis can develop and may require additional treatment.
56 conservatively treated fractures of the patella with small dislocation are analysed. In comparison with plaster cast immobilisation early functional treatment yields the best results.
Symptoms and treatment of 16 years old patient who had osteochondritis dissecans of the patella is discussed. The separated cartilaginous fragment has been surgically removed, subchondral bone multiply drilled. After 3 months of exercises patient returned to the normal level of physical activity.
Eighteen patients with displaced patellar fractures were treated nonoperatively. All of the fractures were displaced by at least 1 cm. Ambulation and knee flexion were encouraged as soon as pain permitted. Twelve of the patients were limited in their activities by medical illnesses. Six of these patients died, and the remaining patients underwent follow-up for 2 years. No patient had severe pain, and only three had acquired significant limitations in their activities from their fractures. Nine patients had either minimal or moderate activity restrictions. There were no complications from treatment. Nonoperative treatment is a reasonable option for displaced fractures of the patella, particularly in patients whose activities are limited by chronic illness. Better results, however, are possible with operative treatment.
In an attempt to re-establish continuity of the quadriceps mechanism following partial patellectomy more securely in patients with comminuted, transverse fractures of the patella, a technique whereby the patellar ligament is inserted into a transverse groove created in the proximal patellar fragment and this anastomosis is then protected by a tension band wiring, is described and depicted. Using this method, it is possible to provide a larger surface area fro more satisfactory tendon to bone healing and to initiate relatively early motion of the knee, without compromising the site of reconstitution of the extensor mechanism.
Nine patients underwent isolated patellar revisions and synovectomies for metallosis secondary to the mechanical failure of metal-backed patellar components. These patients were followed for an average of 5 years (range, 2 to 8 years). In all cases, the femoral and tibial components were left in place, and in one patient the patellar bone was deemed too thin to resurface. Two patients (22%) developed deep infection. One infection (enterococcal) required arthrodesis, and the other (staphylococcal) was successfully managed with a two-staged reimplantation. A third patient sustained an inferior patella pole fracture that was treated conservatively. The remaining six patients are functioning satisfactorily. Metallosis is a serious complication in knee arthroplasty, and these patients merit close follow-up.
Twenty cases with patellar luxation in dogs and cats, in which a sulcoplasty and cranialisation of the tuberositas tibiae were performed, were investigated and reviewed retrospectively. Twelve knees were available for follow-up after a mean period of 15 months. Clinical scoring of patients showed eight with no lameness, three with an occasional weightbearing lameness, and one with a frequent weightbearing lameness. The patella was stable and could not be luxated in ten out of twelve cases. Degenerative joint disease was slightly progressive in the postoperative period. It did not impair the outcome of the procedure.
Starting from the rareness of vertical fractures of the patella, in connection with a clinical case, the authors present this entity and the therapeutical problems in correction with this type of fracture. Interfragmentary diastasis is more than 3 mm, so the authors choose for treatment the osteosynthesis with a spongious screw placed horizontally, perpendicular on the fracture, keeping the integrity of the prepatellar fibrous planes. The authors appreciate that orthopedic treatment is reserved to the incomplete fractures or fractures without displacement.
I describe a case of adolescent tibia vara, a contralateral nonossifying fibroma of the tibia, and bipartite patella, which occurred in an adolescent karate competitor of normal stature. The association of this unusual triad supports the hypothesis that each process has a shared traumatic etiology.
A study of the preoperative assessment, surgical technique and follow-up in 17 surgical procedures (16 patients) indicates that sagital hemipatellectomy is an acceptable alternative form of surgical treatment in patients with chronic painful chondromalacia patellae. The study series comprised 16 patient (mean age, 21 years) in whom the duration of symptoms averaged 5 years, 2 months. In all patients the procedure relieved the pain and permitted a return to their accustomed work and exercise routine within 3 to 6 months after operation. The duration of follow-up is still too short to permit evaluation of possible late complications of this procedure.
An unusual case of chondroblastoma of the patella is presented in which the dominant feature was a hemorrhagic cyst. The chondroblastoma was located in a small gritty mass at one pole of the cyst, which could have easily been overlooked.
We have cloned and sequenced the cDNAs encoding Patella vulgata cyclins A and B. The cDNA clones contain an open reading frame of 426 and 408 amino acids respectively, which present similarity with cyclins from other species. Cyclin A and B RNAs are present as polyadenylated and non-polyadenylated RNA in prophase oocytes and are completely polyadenylated in metaphase I. During the first cleavages after fertilization the level of cyclin A and B mRNAs is high and drops when the free swimming stage is reached. Using p13suc1-Sepharose bead precipitation we demonstrate that cyclin synthesis is triggered during maturation and that inhibition of protein synthesis makes the cyclins disappear rapidly from the metaphase I oocytes, which shift to interphase condition. By microinjecting antisense oligonucleotides into metaphase I oocytes, we demonstrate that in vivo ablation of cyclin A and B messengers together gives the same result, whereas microinjection of only one oligonucleotide does not show any effect.