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PubMedDate not supplied

Treatment of patellofemoral instability in childhood with creation of a femoral sulcus.

Four patients with six knees with patellofemoral instability and severe trochlear dysplasia were treated with creation of a femoral sulcus. None of the six knees have had recurrent dislocations at 3- to 11-year follow-up. All patients had chromosomal abnormalities and limited motor demands. We recommend this procedure for children with patellar instability refractory to standard treatment methods who have severe trochlear dysplasia and limited motor demands.

Adolescent↗
PubMedDate not supplied

Congenital dislocation of the patella and its operative treatment.

Twelve patients with 18 knees whose congenital permanent lateral dislocation of the patella was irreducible by nonoperative means are reported. All knees were operated on according to the same principles, including medial transfer of the patellar tendon. The age of the patients at operation varied between 3 and 19 years. The average follow-up time was greater than 13 years. All patients benefited greatly from the operation. Active knee extension ability was restored in all knees. Some extension deficit remained in two severely dysplastic patients. Congenital subluxation with habitual dislocation of the patella has been successfully treated by the method described.

Adolescent↗
PubMedDate not supplied

Dislocation after total hip arthroplasty. Treatment with an above-knee hip spica cast.

A study was undertaken of 32 dislocations occurring during a nine-year period in 25 of 1280 postoperative total hip arthroplasty patients. Dislocations occurred in 0.6% of 1030 primary procedures, 1.6% of 165 conversions of hemiarthroplasties to total arthroplasties, and 20% of 85 revisions of previous total hip arthroplasties. Average time to dislocation was 31 days after primary procedures and 106 days after revisions. Acetabular cup malposition and poor patient cooperation appeared to be the causes of dislocation after primary procedures. Trochanteric absence or compromise was a factor in dislocation after revision. Treatment consisted of 13 closed reduction and 19 open reductions. An above-knee hip spica cast was employed for six weeks following closed or open reduction in 16 patients. These 16 patients have been followed up for an average of 32 months (28-45 months). Only one redislocation has occurred.

Acetabulum↗
PubMed1992

Patella alta and recurrent dislocation of the patella.

Fifteen knees were treated with a surgical technique designed for recurrent patellar dislocations when associated with patella alta. The average number of patellar dislocations preoperatively was 12, and the determination of patella alta was made using the technique described by Insall and Salvati, which is a ratio of the length of the patellar tendon to the longest diagonal length of the patella. The normal value for this ratio is 1.02 plus or minus 20%. The average preoperative ratio in this study was 1.58 (range, 1.2-2.1), which changed to 1.08 (range, 0.99-1.14) by the time of follow-up examination. The surgical technique used involves transposing the patellar tendon insertion distally without any medialization or recessing and allows for good bone contact for healing, secure fixation, and immediate postoperative motion. There were no recurrences of patellar dislocation postoperatively and few complications. Only one patient complained of anterior knee pain in the follow-up period. This technique is thought to give good results when it is used specifically for recurrent patellar dislocations associated with patella alta.

Adolescent↗
PubMed2005

Bilateral recurrent discloation of the patella associated with below knee amputation: a case report.

BACKGROUND: Recurrent dislocation of the patella in patients with below knee amputation is a known entity. Abnormally high-riding patella (patella alta) and medial patellofemoral ligament insufficiency in these patients predisposes them to patellar instability. The established treatment of this problem is surgical realignment. CASE PRESENTATION: A 25 year old male patient with bilateral below knee amputation presented with bilateral recurrent dislocation of the patella while walking on knees on uneven ground. Clinical and radiographic studies showed patella alta. A simple shoe modification was used to treat this patient. CONCLUSIONS: A simple shoe modification can be used to treat such a condition which is otherwise treated surgically.

Adult↗
PubMed1995

Joint dislocation and cerebral anomalies are consistently associated with oral-facial-digital syndrome type IV.

We present a female patient with the oral-facial-digital syndrome type IV. Our report, the tenth in the literature, describes the typical manifestations of the syndrome, combined with malformations and deformations which have not always been described in the previously reported cases. They include cerebral and renal anomalies, anal atresia and dislocation of elbows and knees.

Abnormalities, Multiple↗
PubMed1994

Duplication of 16q22-->qter confirmed by fluorescence in situ hybridisation and molecular analysis.

We report a female infant with congenital dislocation of the knee and dysmorphic features including a prominent forehead, midface hypoplasia, and micrognathia. Fluorescence in situ hybridisation and PCR amplification of microsatellite repeats were used to show that she had a de novo unbalanced translocation resulting in partial trisomy for 16q and partial monosomy for 15q (46,XX, -15, tder(15)t(15;16)(q26.1;q22). The consequences of partial aneuploidy of 16q are discussed.

Abnormalities, Multiple↗
PubMed1989

Lateral release for recurrent dislocation of the patella.

We reviewed 41 knees after arthroscopic lateral release for recurrent dislocation of the patella at a mean follow-up of four years, and graded the results according to the criteria of Crosby and Insall (1976). There were no dislocations after operation in 28 knees (68%); the less satisfactory results were in patients with subluxation of the patella on extension of the knee and those with generalised ligamentous laxity. There were no complications. A characteristic and previously unreported lesion of the patellar surface was seen in eight of the 41 knees. The results of lateral release are better than those reported for other techniques. This treatment, by either open or arthroscopic methods, is recommended.

Adult↗
PubMed1976

The clinical manifestations and pathomechanics of contracture of the extensor mechanism of the knee.

Experience with thirty-eight Asian children and adolescents who presented with either stiffness of the knee, genu recurvatum, habitual dislocation of the patella or congenital lateral dislocation of the patella showed that all those disorders were manifestations of contracture of the extensor mechanism, which fell into two groups according to the components involved. In Group I the main components affected were in the midline of the limb, namely rectus femoris and vastus intermedius; these patients presented with varying degrees of stiffness of the knee, or worse, with genu recurvatum. In Group II the main components involved were lateral to the midline of the limb, namely vastus lateralis and the ilio-tibial band; these patients presented with habitual dislocation of the patella, or worse, congenital lateral dislocation of the patella. In both groups untreated patients developed secondary adaptive changes such as subluxation of the tibia or marked genu valgum which made operative procedures more formidable and less effective. Release of the contracture should therefore be performed as early as possible.

Adolescent↗
PubMed1977

[Knee arthroplasty. Our experiences with 22 cases].

In spite of continuing progress, total knee arthroplasty still presents many problems. In this clinic 25 arthroplasties have been performed in 22 patients over the last 4 1/2 years. Guépar hinges were used in 21 knees and Marmor modular knees in 4. Acrylic cement was used in all cases. The mean age of the patients was 69 years. 13 had osteoarthritis, 5 rheumatoid disease and 4 other conditions. There were no serious general complications or infections in the early postoperative period. The commonest local complication was malalignment of the patella (17 cases); 2 of these were complete but reducible dislocations. In only 3 knees did patellar subluxation produce sufficient pain to spoil an otherwise good result. Prostheses have loosened in 2 knees, one of which has been fused with success. Striking features of the early results have been reliable pain relief, improvement of joint movement, and generally an increased walking capacity. In spite of its present problems, arthroplasty remains the procedure of choice in knees where the amount of articular damage contraindicates conservative surgery.

Aged↗
PubMed1988

Patellar fracture type and prognosis in condylar total knee arthroplasty.

Fractures of the patella occurred following implantation of 36 condylar total knee arthroplasties in 35 patients. The end results were evaluated in relation to fracture type after an average 4.5-year follow-up period. The follow-up observations included a physical examination, quantitative knee score, and roentgenographic evaluations of extremity alignment and implant position. Twenty-two of the 36 knees had a good or excellent knee score and 14 had a fair or worse score at the time of the latest follow-up evaluation. The satisfactory knees had an average arc of motion of 100 degrees, while the unsatisfactory knees had an average arc of motion of 80 degrees. Fourteen fractures through the mid-body or superior pole of the patella not involving the implant, cement, or quadriceps mechanism (Type I) and two nondisplaced fractures through the inferior pole of the patella (Type IIIB) were managed nonoperatively, with all knees rating either a good or excellent score. Fractures of the patella disrupting the quadriceps mechanism or implant/bone/cement composite (Type II) were managed operatively in the six knees. Fractures of the inferior pole of the patella with disruption of the patellar ligament (Type IIIA) were managed operatively in seven of eight knees (one patient refused surgery). Lateral fracture-dislocations were managed operatively in all six knees. Six of the knees operated upon had a good or better score, and nine knees were rated as poor or failed. Those fractures alignment and implant position were seen had the more severe patellar fractures and poorest outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Use of a modified Elmslie-Trillat procedure to improve abnormal patellar congruence angle.

Forty patients underwent 45 modified Elmslie-Trillat realignment procedures (mean followup, 2 years) for refractory patellar instability (34 knees) or painful patellofemoral syndrome with malalignment (11 knees). The postoperative congruence angle (mean, +3.4 degrees) was significantly improved compared with the preoperative value (mean, +21.5 degrees). We considered the "normal" congruence angle average as -8 degrees (range, -20 degrees to +4 degrees). Over time postoperatively, we detected no statistical difference in the congruence angle (5 months, 3.4 degrees; 24 months, 6.3 degrees). There were no patellar dislocations postoperatively. Nine knees (20%) had some postoperative subluxation. Ninety-four percent of the patients without subluxation had congruence angles less than 15 degrees, whereas 54% of patients with postoperative subluxation had postoperative congruence angles greater than 15 degrees. The evidence in this study population indicates that the modified Elmslie-Trillat procedure can predictably improve the patellar congruence angle. Adequate correction may eliminate patellar dislocation. Correction of the congruence angle to less than +15 degrees will result in a decreased incidence of postoperative patellar instability. Early full activity postoperatively did not affect the modified Elmslie-Trillat correction of the congruence angle being maintained over time.

Adolescent↗
PubMed2001

GDF-5 deficiency in mice alters the ultrastructure, mechanical properties and composition of the Achilles tendon.

Acromesomelic dysplasia of the Hunter-Thompson and Grebe types are rare human disorders based on growth/differentiation factor (GDF)-5/CDMP-1 genetic mutations. Numerous skeletal abnormalities are present in these individuals, including shortened limb bones and severe dislocations of the knee. In the GDF-5 deficient brachypodism mouse, similar, although less severe, phenotypes are observed. It is unknown whether the joint dislocations observed in these disorders are due to a defect in the original formation of joints such as the knee, or to abnormalities in the tendons and ligaments themselves. We hypothesized that tendons from GDF-5 deficient mice would exhibit altered composition, mechanical properties, and ultrastructure when compared with heterozygous control littermates. GDF-5 deficient Achilles tendons were structurally weaker than controls, and structural strength differences appeared to be caused by compromised material properties: after normalizing by collagen per unit length, mutant tendons were still 50% weaker (P < 0.0001) and 50% more compliant (P < 0.001) than controls. Despite comparable levels of skeletal maturity in the two cohorts, the majority of mutant tendon failures occurred in the mid-substance of the tendon (64% of all failures), whereas the majority of control failures occurred via avulsion (92% of all failures). Mutant Achilles tendons contained 40% less collagen per microgram of DNA when compared to controls (P = 0.004). No significant difference in glycosaminoglycan (GAG)/DNA was detected. Ultrastructural analyses indicated a slight trend toward increased frequency of small diameter (30-100 nm) collagen fibrils in the mutant Achilles. Our findings suggest that increased tendon and ligament laxity may be the cause of the joint dislocations seen in patients with Hunter-Thompson and Grebe type dysplasia, rather than developmental abnormalities in the joints themselves.

Achilles Tendon↗
PubMedDate not supplied

Surgical treatment of congenital dislocation of the patella.

Eleven patients with 17 involved knees were surgically treated for congenital dislocation of the patella between 1978 and 1993. Ten patients with 13 involved knees followed up for a minimum of 2 years postoperatively composed the study group. Six patients had both involved knees operatively treated. In four patients, congenital dislocation of the patella was associated with a recognizable syndrome. All patients had fixed, painful lateral dislocation of the patella that could not be reduced. The average age at presentation was 7 years and 9 months (range, 2 months to 15 years). All patients underwent an extensive procedure including lateral release and advancement of the vastus medialis obliquus. Skeletally immature children underwent medial transfer of the entire patellar tendon. Skeletally mature patients underwent medial transfer of the tibial tubercle. Ten patients with 13 involved knees were followed up for > or = 2 years. Mean follow-up was 5.1 years (range, 1-17.5). At last follow-up, all patients reported a marked increase in activity tolerance and relief of pain. Average extension lag improved from 15 degrees before to 2 degrees after surgery. One superficial wound infection occurred; no patient developed a deep infection. One peroneal neurapraxia occurred but resolved with observation. Redislocation of the patella occurred in the immediate postoperative period in one patient. Operative treatment of congenital dislocation of the patella can predictably improve knee function when all aspects of the complex pathologic anatomy are addressed.

Adolescent↗