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At least 1,423 records · Page 79Linked to original sources
PubMed2002

Muscular control of the patella.

Patellofemoral patients are among the most common yet most challenging individuals presenting for orthopedic care. The key word in the previous sentence is individual. A single protocol of care is not sufficient for these special "individuals." Many concepts have been evaluated through review of the peer-reviewed literature with the following highlights: (1) the concept of VMO isolation through specific exercise should no longer be part of our lexicon; (2) patellofemoral patients improve when they are able to enhance quadriceps functional patterns by way of pain-free exercise; (3) patellofemoral patients do not fit into a single "box" but rather require an evaluation-based classification and specific interventional pattern. Many of the special techniques used by clinicians in treating these patients have not been well defined through research and also are lacking in evidence of clinical efficacy. We also must recognize, however, that good clinical observations can be the first step in defining what questions should be asked and how they can be answered. It is vital that we answer the questions without allowing "bad science" through dogma and anecdote to prevail. Likewise, we need to be diligent in determining our successes and failures through well designed and implemented clinical and research studies.

Exercise↗
PubMed1997

Osteochondritis dissecans of the distal femur and patella.

Osteochondritis dissecans (OCD) is a pathologic process characterized by a partial or total separation of a fragment of bone with overlying articular cartilage. OCD may affect any joint, but the knee joint is affected most commonly. This article reviews several potential causes of OCD and classification systems for OCD. Diagnosis and treatment strategies are discussed.

Diagnostic Imaging↗
PubMed1987

Fenestrated medial patella plica.

Fenestrated medial patellar plicae are unusual. In a review of 1,000 consecutive knee arthroscopies, the incidence of this finding was 1.8%. These fenestrations may vary in size and shape from being small, circular, and only 5 mm in diameter to being lengthwise openings 3-4 cm long. There is a high prevalence of associated medial knee symptoms (80%) that are relieved by complete resection. Since the plical fenestration does not appear to abrade the articular cartilage, symptoms are probably the result of medial wall inflammation.

Adolescent↗
PubMed1987

Lateral retinacular release of the patella.

From October 1977 through January 1984, 2,330 arthroscopic procedures of the knee were performed by one of the authors (G.J.S.). Among these procedures, 35 lateral retinacular releases were performed through minimal, lateral incisions. Twenty-two knees in 22 patients were available for follow-up evaluation, and these cases were reviewed retrospectively. The average age of the patients at the time of surgery was 22.6 years. The average follow-up period was 48 months. The patients were divided into three subgroups on the basis of their preoperative diagnosis. Group I (eight knees) had a history of patellar dislocations; group II (seven knees) had recurrent patellar subluxation, identified by history and physical and radiographic examinations; and group III (seven knees) had patellar pain without a history of dislocations or subluxation and with no symptoms of instability. All of these patients underwent diagnostic arthroscopy and lateral retinacular release, as well as arthroscopic treatment of associated pathology. Postoperatively and at the time of followup, all patients were evaluated for pain, function and patellar instability. In 15 patients with a history of patellar dislocation or subluxation, 67% were found to have had significant improvement in their symptoms, which was borne out by the findings during physical examination. None was worse following treatment. Among the seven patients with no history of patellar dislocation or subluxation, only one of the seven had a satisfactory result. Based upon the findings of this study, it was concluded that arthroscopic lateral retinacular release is a reasonable, initial step in the surgical treatment of patellar dislocation or subluxation, resistant to conservative treatment. Its efficacy in cases of recalcitrant patellar pain without a history of instability is doubtful.

Adolescent↗
PubMed1991

The metal-backed patella. An invitation for failure?

Thirty-one cases of failed metal-backed patellar components requiring revision surgery are reviewed. Two modes of implant failure onset were noted. Within each group, delays in patient presentation and diagnosis of the failed component were encountered. The syndrome of the failed metal-backed patellar component is proposed. The authors conclude that: (1) more of these failures will be seen in the future; (2) this patient population needs appropriate counsel concerning the signs and symptoms of this syndrome as well as more frequent follow-up evaluations; (3) surgeons treating this complication should be prepared to revise all components; and (4) the use of metal-backed patellar components should be discontinued.

Aged↗
PubMed1997

6- to 10-year experience using countersunk metal-backed patellas.

Three hundred two consecutive cementless total knee arthroplasties (Natural Knee, Intermedics Orthopedics, Inc., Austin, TX) were performed using a metal-backed, porous-coated patellar component. Fifty-nine patients died and 31 were lost to follow-up evaluation, resulting in 212 knees available for evaluation at 6 to 10 years. The mean follow-up period was 91 months. The mean modified Hospital for Special Surgery total knee score improved from 58 before surgery to 98 at the most recent follow-up visit. Mean patellar translation and tilt were 2.75 mm and 3.5 degrees, respectively. There were no patellar lucencies nor loosening. Eleven patients (5%) underwent revision of the patellar component. Overall patellar survivorship was 96%. Comparatively good results can be achieved with the use of a metal-backed patellar component if component design, surgical technique, and patellar alignment are properly addressed.

Adult↗