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Geriatric Orthopaedic Surgery &... Sep 2017To review comminuted patella fracture in the elderly patients and examine the surgical options to avoid complications such as fixation failure and poor functional...
OBJECTIVES
To review comminuted patella fracture in the elderly patients and examine the surgical options to avoid complications such as fixation failure and poor functional outcome. To provide an example of mesh augmentation in comminuted patella fracture in the elderly patients.
DATA SOURCES
A literature review was conducted by the authors independently using Ovid, Medline, Cochrane, PubMed, and Clinical Key in English. We aimed to review data on patients older than 65 with comminuted patella fracture. Search conducted between July and December 2015.
STUDY SELECTION
Search terms included patella fracture, elderly, and fixation failure. Abstracts were included if they were a case report, cohort series, or randomized control trial. Further inclusion criteria were that they were available in full text and included patient age(s), operative details, follow-up, and outcome discussion.
DATA EXTRACTION
Each study was assessed according to its level of evidence, number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized.
DATA SYNTHESIS
Paucity of data and heterogeneity of studies limited statistical analysis. Data are presented as a review table with the key points summarized.
CONCLUSION
In patella fracture, age >65 years and comminuted fracture pattern are predictors of increased fixation failure and postoperative stiffness, warranting special consideration. There is a trend toward improved functional outcomes when augmented fixation using mesh or plates is used in this group. Further level 1 studies are required to compare and validate new treatment options and compared them to standard surgical technique of tension band wire construct.
PubMed: 28835869
DOI: 10.1177/2151458517710517 -
Knee Surgery, Sports Traumatology,... Sep 2023The aim of our study was to perform a systematic review and best knowledge synthesis of the present literature concerning the familial association and epidemiological... (Review)
Review
Familial association and epidemilogical factors as risk factors for developing first time and recurrent patella dislocation: a systematic review and best knowledge synthesis of present literature.
PURPOSE
The aim of our study was to perform a systematic review and best knowledge synthesis of the present literature concerning the familial association and epidemiological factors as risk factors for developing first-time and recurrent patella dislocation.
METHODS
The study was conducted according to the PRISMA guidelines and registered in PROSPERO. EMBASE and PubMed were systematically searched on the 5th of May 2022. Studies investigating participants with genetic and epidemiological risk factors for the first time as well as recurrent patella dislocation were included. The records were screened, and data were extracted independently by two researchers supervised by a third independent assessor.
RESULTS
A total of 6,649 records were screened, and 67 studies were included. Familial association was described as a risk factor for patella dislocation in 17 studies. One study found that participants with a family history of patella dislocation had a 3.7 higher risk for patella dislocation in the contralateral asymptomatic knee, and another study found a family history of PD in 9% of 74 participants. Eleven studies found an accumulation of patella dislocation across generations in specific families. Additionally, a range of genetic syndromes was associated with patella dislocation. Young age is a well-investigated risk factor for patella dislocation, but the results are inconsistent. Only five and eight studies investigated skeletal immaturity and gender as risk factors for patella dislocation, respectively.
CONCLUSION
There may be a familial association with patella dislocation, but further investigation is necessary to determine the strength and etiology of the association. There is weak evidence that epidemiological risk factors, such as age, skeletal immaturity, gender, and BMI are risk factors for patella dislocation.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Patella; Recurrence; Patellar Dislocation; Risk Factors; Knee Joint; Joint Dislocations
PubMed: 36629887
DOI: 10.1007/s00167-022-07265-z -
The Knee Mar 2016Recent meta-analyses support not resurfacing the patella at the time of TKA. Several different modes of intervention are reported for non-resurfacing management of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recent meta-analyses support not resurfacing the patella at the time of TKA. Several different modes of intervention are reported for non-resurfacing management of the patella at TKA.
METHODS
We have conducted a systematic review and meta-analysis of non-resurfacing interventions in TKA. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study methodology and reporting system was adopted, utilising the PRISMA checklist and statement. Classes of patella interventions were defined as: 0. No intervention. 1. Osteophyte excision only. 2. Osteophyte excision, denervation, with soft tissue debridement. 3. Osteophyte excision, denervation, soft tissue debridement, and drilling or micro-fracture of eburnated bone. 4. Patellar resurfacing. A meta-analysis was conducted upon the pre- and post-operative KSS for each technique.
RESULTS
Four hundred and twenty-three studies were identified, 12 studies met the inclusion criteria for the systematic review and eight for the meta-analysis. Two studies compared different non-resurfacing patellar techniques, the other studies used the non-resurfacing cohort as controls for their prospective RCTs comparing patellar resurfacing with non-resurfacing. The meta-analysis revealed no significant difference between the techniques.
CONCLUSIONS
We conclude that there is no significant difference in KSS for differing non-resurfacing patellar techniques, but further trials using patellofemoral specific scores may better demonstrate superior efficacy of specific classes of patella intervention, by virtue of greater sensitivity for patellofemoral pain and dysfunction.
LEVEL OF EVIDENCE
I.
Topics: Arthroplasty, Replacement, Knee; Debridement; Humans; Osteoarthritis, Knee; Patella; Reoperation
PubMed: 26846465
DOI: 10.1016/j.knee.2015.10.012 -
Knee Surgery & Related Research Jun 2023Hoffa's fat pad syndrome has been defined as impingement of Hoffa's fat pad, leading to oedema and fibrosis. The primary aim of this systematic review was to identify... (Review)
Review
BACKGROUND
Hoffa's fat pad syndrome has been defined as impingement of Hoffa's fat pad, leading to oedema and fibrosis. The primary aim of this systematic review was to identify morphological differences in Hoffa's fat pad between patients with and without Hoffa's fat pad syndrome, evaluating them as risk factors predisposing to its development. The secondary aim was to summarize and evaluate current evidence pertaining to the management of Hoffa's fat pad syndrome.
MATERIALS AND METHODS
The protocol for this review was prospectively registered (PROSPERO registration: CRD42022357036). Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. All studies evaluating differences in Hoffa's fat pad anatomy under imaging between patients with and without Hoffa's fat pad syndrome were included, as well as those exploring epidemiological factors predisposing to its development (ethnicity, employment status, sex, age and BMI), and studies reporting on the effect of treatment on Hoffa's fat pad morphology.
RESULTS
A total of 3871 records were screened. Twenty one articles satisfied the inclusion criteria, evaluating 3603 knees of 3518 patients. Patella alta, increased tibial tubercle-tibial groove distance, and increased trochlear angle were found to predispose the development of Hoffa's fat pad syndrome. Trochlear inclination, sulcus angle, patient age and BMI were not associated with this condition. The link between Hoffa's fat pad syndrome and ethnicity, employment, patellar alignment, Hoffa's fat pad composition, physical activity and other pathological processes cannot be established due to lack of evidence. No studies reporting on treatment for Hoffa's fat pad syndrome were identified. Though weight loss and gene therapy may provide symptomatic relief, further research is required to corroborate these claims.
CONCLUSION
Current evidence suggests that high patellar height, TT-TG distance, and trochlear angle predispose the development of Hoffa's fat pad syndrome. In addition, trochlear inclination, sulcus angle, patient age and BMI do not seem to be associated with this condition. Further research should explore the link between Hoffa's fat pad syndrome and sport as well as other conditions pertaining to the knee. In addition, further study evaluating treatment approaches for Hoffa's fat pad syndrome is required.
PubMed: 37296488
DOI: 10.1186/s43019-023-00192-4 -
Journal of Orthopaedics 2020Patellar dislocations are a significant injury with the potential for long term problems. Little work has been done on establishing the mechanism by which this injury... (Review)
Review
BACKGROUND
Patellar dislocations are a significant injury with the potential for long term problems. Little work has been done on establishing the mechanism by which this injury occurs.
OBJECTIVES
To determine the mechanism of injury of a patella dislocation based on the available published literature and compare them to already proposed theories.
METHODS
A systematic review of the literature was conducted following searches performed on MEDLINE, EMBASE and ProQuest from the earliest year of indexing using the following search terms in any combination: "patella", "dislocation", "mechanism of injury", "anatomy", "biomechanical" and "risk factor". A broad inclusion criteria was used that included studies that looked at patellar dislocations and instability with respect to the patellofemoral joint (PFJ) kinematics or altered kinematics of the PFJ. Studies that did not address the kinematics or biomechanics of the PFJ were excluded. Studies were appraised based on their methodology using a combination of the Critical Appraisal Skills Programme tool and the Quality Appraisal for Cadaveric Studies.
RESULTS
113 studies were identified from a search of MEDLINE, EMBASE and ProQuest databases. Following application of our inclusion criteria, a total of 23 studies were included in our review. 18 of these studies were cadaveric biomechanical studies. The remaining studies were anatomical, imaging based, and a computer simulation based study.
CONCLUSIONS
These biomechanical and kinematic studies provide some evidence that a dislocation is likely to occur during early knee flexion with external rotation of the tibia and contraction of the quadriceps. There is limited evidence to support other elements of proposed mechanisms of dislocation.
PubMed: 32042233
DOI: 10.1016/j.jor.2019.11.018 -
Cartilage Dec 2021This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following...
PURPOSE
This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following patellofemoral cartilage restoration surgery.
METHODS
This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, EMBASE, and Cochrane Library databases were searched up to August 31, 2018, to identify clinical studies that assessed surgical outcomes of patellofemoral cartilage restoration surgery. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess study quality.
RESULTS
Forty-two studies were included comprising 1,311 knees (mean age of 33.7 years and 56% males) and 1,309 patellofemoral defects (891 patella, 254 trochlear, 95 bipolar, and 69 multiple defects, including the patella or trochlea) at a mean follow-up of 59.2 months. Restoration techniques included autologous chondrocyte implantation (56%), particulated juvenile allograft cartilage (12%), autologous matrix-induced chondrogenesis (9%), osteochondral autologous transplantation (9%), and osteochondral allograft transplantation (7%). Significant improvement in at least one score was present in almost all studies and these surpassed the minimal clinically important difference threshold. There was a weighted 19%, 35%, and 6% rate of reported complications, reoperations, and failures, respectively. Concomitant patellofemoral surgery (51% of patients) mostly did not lead to statistically different postoperative outcomes.
CONCLUSION
Numerous patellofemoral restoration techniques result in significant functional improvement with a low rate of failure. No definitive conclusions could be made to determine the best surgical technique since comparative studies on this topic are rare, and treatment choice should be made according to specific patient and defect characteristics.
LEVEL OF EVIDENCE
Level IV, systematic review of level II to IV studies.
Topics: Adult; Aged; Cartilage Diseases; Cartilage, Articular; Chondrocytes; Female; Humans; Male; Middle Aged; Patella; Transplantation, Autologous
PubMed: 31845590
DOI: 10.1177/1947603519893076 -
The Knee Mar 2023The purpose of this systematic review was to evaluate outcomes and complications rates between inlay and onlay patellofemoral arthroplasty (PFA). (Review)
Review
PURPOSE
The purpose of this systematic review was to evaluate outcomes and complications rates between inlay and onlay patellofemoral arthroplasty (PFA).
METHODS
According to the PRISMA statement, 42 studies with 2552 patients were included. Data considered for quantitative analysis consisted of the Knee Society Score (KSS), the range of motion (ROM), the visual analogue score (VAS), and the Western Ontario and McMaster Universities questionnaire (WOMAC). Complications and revision surgery were considered.
RESULTS
Data on postoperative KSS showed no differences between the groups. The ROM was evaluated in 8 studies for 70 and 331 inlay and onlay PFA, respectively. Onlay group was favorable in terms of postoperative ROM. Postoperative VAS was available for 64 inlay and 110 onlay and no differences were found. Data on postoperative WOMAC were available for 49 inlay and 527 onlay PFA and inlay group showed better scores. A statistically significant higher rate of instability, persistent pain, malposition, stiffness, deep infection, disease progression, and wear of the patellar component were noted in the inlay group. A higher rate of lateral release was noted in the onlay group. A higher number of manipulations under anesthesia was noted in the inlay group. The revision to total knee arthroplasty was reported more frequently in the inlay group.
CONCLUSION
A higher rate of conversion to total knee arthroplasty and complication rates after inlay technique was found. The potential of achieving better WOMAC scores with the inlay technique should be weighed against the higher complication and revision rates compared to the onlay technique.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Knee Prosthesis; Treatment Outcome; Osteoarthritis, Knee; Arthroplasty, Replacement, Knee; Patella; Knee Joint
PubMed: 36680866
DOI: 10.1016/j.knee.2023.01.001 -
The Journal of Knee Surgery Oct 2016The medial patellofemoral ligament (MPFL) plays a key role in lateral patellofemoral stability, and there has been significant clinical and research interest in MPFL... (Review)
Review
The medial patellofemoral ligament (MPFL) plays a key role in lateral patellofemoral stability, and there has been significant clinical and research interest in MPFL reconstruction (MPFLR) in recent years. The primary objective of this systematic review of clinical studies is to investigate the reported indications for an isolated MPFLR and secondarily to examine some of the reasons reported for not performing an isolated MPFLR. A comprehensive search of the MEDLINE, EMBASE, PUBMED, and Cochrane databases was conducted to identify surgical studies investigating MPFLR. Study information including author, publication date, sample size, patient age, follow-up period, procedure performed, surgical indications and contraindications, and study design were extracted. The most common indication for isolated MPFLR was recurrent patellofemoral instability (82.1%). Common reasons given for not performing an isolated MPFLR included bony malalignment (51.8%), trochlear dysplasia (30.4%), and patella alta (23.2%). This systematic review identified recurrent patellofemoral instability as the primary indication for an isolated MPFLR; however, a large number of the studies did not provide clear criteria for when an isolated MPFLR should be performed. Similarly, there was significant variability in the reasons given for not performing an isolated MPFLR.
Topics: Humans; Joint Dislocations; Joint Instability; Ligaments, Articular; Patellofemoral Joint; Plastic Surgery Procedures
PubMed: 26516072
DOI: 10.1055/s-0035-1564730 -
Voprosy Pitaniia 2023Muscle weakness and atrophy of the quadriceps muscle after anterior cruciate ligament reconstruction may persist for up to 6 months after surgery and cause re-injury to...
Muscle weakness and atrophy of the quadriceps muscle after anterior cruciate ligament reconstruction may persist for up to 6 months after surgery and cause re-injury to the ipsilateral or contralateral limbs. Many authors state that adequate nutritional status during the rehabilitation period can contribute to faster postoperative recovery of muscle mass and strength of the lower limb, be an adjunct to exercise, or serve an alternative treatment strategy. of the research was to conduct a systematic review of the literature and evaluate the degree of influence of dietary supplements on muscle mass and strength of the operated limb after reconstruction of the anterior cruciate ligament (ACL). . The search for articles was carried out in international databases PubMed, Google Scholar, Cochrane Library. The time frame of the search was 22 years. To be included in the review, studies had to meet the PICOS criteria: participants were men and women over 18 years of age after ACL reconstruction; intervention - supplementation after and/or before and after ACL reconstruction; comparison - placebo group or no supplementary interventions; results - assessment of the dynamics of changes in muscle mass (cross-sectional area, muscle thickness or size of skeletal muscle fibers) and / or maximum strength (dynamic or isometric) of the operated limb; research design - randomized controlled trials (RCT). The quality of selected RCTs was assessed using the Cochrane Collaboration Risk of Bias (RoB 2) tool. . A total of 1397 articles were found after searching in the databases. This systematic review included 6 RCTs with a total number of patients 186. The following dietary supplements were used: leucine - 1 article, glucosam ine - 1 article, creatine - 1 article, vitamins E and C - 2 articles. One study evaluated the effect of whey protein supplementation in combination with neuromuscular electrical stimulation on isometric strength of the operated limb. When comparing the data of 3 groups in the pre- and postoperative periods, there were no statistically significant differences between the groups. When considering the protocols for taking dietary supplements based on creatine, glucosamine, vitamins E and C, none of the studies demonstrated statistically significant improvements in the parameters of maximum strength or muscle hypertrophy of the operated limb in the main groups compared with the control groups. Also, no results have been obtained indicating that these dietary supplements can slow down muscl e atrophy after surgery. In another study that evaluated the effect of leucine supplementation, by the end of the rehabilitation program, the muscle strength of the operated limb tended to increase more in the leucine group than in the placebo group, but without a statistically significant difference. At 10 cm from the patella, the femoral circumference of the operated limb in the leucine group increased more than in the placebo group, and the differences were statistically significant (р=0.009). Two studies were rated as high risk of bias, three as moderate risk, and one as low risk. . None of the supplements used had a statistically significant effect on the muscle strength of the operated limb after ACL reconstru ction. In terms of thigh muscle hypertrophy, the only significant improvement was associated with leucine supplementation and an increase in thigh circumference at a distance of 10 cm from the patella.
Topics: Male; Female; Humans; Adolescent; Adult; Anterior Cruciate Ligament Injuries; Whey Proteins; Creatine; Leucine; Quadriceps Muscle; Atrophy; Dietary Supplements; Anterior Cruciate Ligament Reconstruction; Vitamins; Randomized Controlled Trials as Topic
PubMed: 37346024
DOI: 10.33029/0042-8833-2023-92-2-87-96 -
European Journal of Orthopaedic Surgery... May 2022The primary aim of the study is to compare the patient outcome in medial patellofemoral ligament reconstruction (MPFLR) or MPFLR concurrent with trochleoplasty... (Review)
Review
Medial patellofemoral ligament reconstruction with and without trochleoplasty for patients with patella instability-correlation of trochlear dysplasia and patient outcome, classification and outcome measure in the past decade-a systematic review.
PURPOSE
The primary aim of the study is to compare the patient outcome in medial patellofemoral ligament reconstruction (MPFLR) or MPFLR concurrent with trochleoplasty (MPFLR + TP) and correlate it with the degree of trochlear dysplasia (TD). The secondary aim is to review TD classification, outcome measure, chronological and geographical trend of such studies in the past decade.
METHODS
A systemic review of the literature in the past decade on studies of patients with patella instability and underwent either a MPFLR or MPFLR + TP. The degree of TD with the patient outcome was correlated and compared between the 2 groups. The TD classification, outcome measures, chronological and geographical trends of these studies were documented.
RESULTS
There is no statistical difference in the overall improvement in the compared outcome scores between the 2 groups. However, the MPFLR studies reported a total of 16 re-dislocation in contrast to none in the MPFLR + TP studies. The 24 selected studies in the current review utilized different TD classification as well as outcome measures. A more homogeneous subgroup of 12 studies utilized Dejour classification as well as Kujala score that enabled comparison and showed no significant difference in outcome. The highest number of MPFLR publications was in 2019 and was from North and South Americas, Asia and Europe. The MPFLR + TP studies were from Europe during 2013 to 2017.
CONCLUSION
Though there is an overall improvement in post-operative outcomes scores with no statistical significance between MPFLR and MPFLR + TP, the documented re-dislocations in the MPFLR studies suggested an undetermined zone where the choice of procedure could result in a different outcome. The current review did not show correlation between the degree of TD with the patient outcome to provide a clear indication for either procedure according to the degree of TD. The diverse TD classifications and varied outcome measures indicated the need for standardization and consistency in documentation to guide the treating clinician in the choice of procedure. MPFLR was more commonly performed and studied than MPFLR + TP in the past decade.
Topics: Humans; Joint Dislocations; Joint Instability; Ligaments, Articular; Outcome Assessment, Health Care; Patella; Patellar Dislocation; Patellofemoral Joint
PubMed: 34120236
DOI: 10.1007/s00590-021-03030-z